[Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making]

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Diagnostic Imaging

Background:

• A notable proportion of coronary angiographies (25%) show coronary artery stenosis below 50% despite symptoms of myocardial ischemia.
• This finding has spurred significant interest in understanding conditions like myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary arteries (INOCA).
• Recent guidelines from the American Society of Cardiology address the pathophysiology, diagnosis, and treatment of these entities.

Purpose of the Study:

• To conduct a narrative review on the physiopathologic and diagnostic aspects of MINOCA and INOCA.
• To reflect the consensus and opinions of expert cardiologists from various centers in Argentina.
• To provide an updated understanding of the current diagnostic and therapeutic approaches for patients presenting with MINOCA and INOCA.

Main Methods:

• A narrative review methodology was employed.
• Expert opinions from cardiologists across different Argentine centers were gathered.
• Literature was reviewed focusing on the pathophysiology and diagnostic challenges of MINOCA and INOCA.

Main Results:

• The review highlights the increasing clinical recognition of MINOCA and INOCA.
• It emphasizes the complexity in diagnosing these conditions due to non-obstructive coronary findings.
• Expert consensus points towards the need for a multi-faceted diagnostic approach.

Conclusions:

• MINOCA and INOCA represent significant clinical challenges in cardiology.
• Accurate diagnosis requires a thorough understanding of underlying physiopathologic mechanisms beyond epicardial coronary stenosis.
• Further research and standardized diagnostic protocols are essential for optimal patient management.