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Published on: August 17, 2022
[Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making]
Hernán Cohen Arazi1,2, Ricardo Iglesias1, Ernesto Duronto3
1Servicio de Cardiología, Sanatorio Trinidad Mitre, Argentina.
Insights
A significant number of coronary angiographies reveal minimal stenosis (<50%), prompting interest in myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary arteries (INOCA). This review explores their pathophysiology and diagnosis.
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.
Abstract:
One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).
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