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Myocardial Infarction with Non-Obstructive Coronary Arteries: To Stent or Not to Stent? That is the Question

Suddharsan Subbramaniyam1, Devashish Sheel1, Nooraldaem Yousif1

  • 1Mohammed Bin Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain.

Heart Views : the Official Journal of the Gulf Heart Association
|March 25, 2022
PubMed

Insights

Myocardial infarction with nonobstructive coronary arteries (MINOCA) in ST-elevation myocardial infarction (STEMI) presents treatment challenges. Optical coherence tomography (OCT) guided stenting in a MINOCA case with a ruptured plaque, aiding clinical decisions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Myocardial infarction with nonobstructive coronary arteries (MINOCA) in the setting of acute ST-elevation myocardial infarction (STEMI) lacks clear management guidelines.
  • Decisions regarding intervention, such as stenting, are often complex in MINOCA cases.

Observation:

  • A patient presented with extensive anterior wall STEMI.
  • Coronary angiography revealed nonobstructive coronary arteries, classifying the event as MINOCA.
  • Optical coherence tomography (OCT) identified a ruptured plaque in the proximal left anterior descending artery.

Findings:

  • The case highlights the utility of OCT in evaluating MINOCA.
  • OCT findings of plaque rupture in a high-risk clinical presentation informed the decision for intervention.
  • Percutaneous coronary intervention with stenting of the proximal left anterior descending artery was performed.

Implications:

  • OCT can provide crucial information for guiding treatment decisions in MINOCA.
  • This approach may help optimize management strategies for MINOCA patients with STEMI.
  • Further research into OCT-guided therapy for MINOCA is warranted.

Keywords:
Coronary artery diseaseST elevation myocardial infarctionmyocardial infarctionmyocardial infarction with nonobstructive coronary arteriesoptical coherence tomographyplaque rupture

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