OCT Findings in MINOCA

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Medicine

Background:

• Myocardial infarction with non-obstructive coronary artery disease (MINOCA) presents a diagnostic challenge due to its heterogeneous nature.
• Identifying the specific etiology of MINOCA is crucial for effective patient management and improved outcomes.
• Traditional angiography may not reveal the underlying causes of MINOCA, necessitating advanced imaging techniques.

Purpose of the Study:

• To review the role of Optical Coherence Tomography (OCT) in diagnosing patients with MINOCA.
• To explore how OCT, particularly when combined with Cardiac Magnetic Resonance (CMR), aids in identifying MINOCA mechanisms.
• To recommend the integrated use of OCT and CMR for MINOCA diagnosis and management.

Main Methods:

• Narrative review of existing literature on OCT and CMR in MINOCA.
• Discussion of OCT's high-resolution capabilities for characterizing coronary tissue and plaque morphology.
• Analysis of studies combining OCT and CMR for comprehensive MINOCA etiological assessment.

Main Results:

• OCT identifies abnormal findings in nearly half of MINOCA patients, revealing causes like plaque disruption, spontaneous coronary artery dissection, or spasm.
• The combination of OCT and CMR significantly enhances the ability to identify the majority of underlying MINOCA mechanisms.
• OCT's high resolution allows detailed differentiation of plaque characteristics, such as thin cap fibroatheroma, rupture, or erosion.

Conclusions:

• OCT is a valuable tool in the diagnostic workup of MINOCA, providing crucial insights into coronary pathology.
• Combining OCT with CMR imaging is recommended for a more complete etiological diagnosis in MINOCA patients.
• Further prospective studies are essential to optimize MINOCA management strategies and reduce patient morbidity and mortality.