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Myocardial Infarction with Nonobstructive Coronary Arteries
1Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA;
Annual Review of Medicine
|September 30, 2022
Summary
Myocardial infarction with nonobstructive coronary arteries (MINOCA) affects 6-8% of heart attack patients. Diagnosing MINOCA requires systematic approaches, as its causes and optimal treatments remain uncertain.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Internal Medicine
Background:
- Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a distinct subtype of myocardial infarction (MI).
- MINOCA accounts for 6-8% of spontaneous MI cases undergoing coronary angiography.
- This condition disproportionately affects women but also occurs in men.
Purpose of the Study:
- To highlight the variability in MINOCA pathogenesis compared to MI with obstructive coronary artery disease (MI-CAD).
- To emphasize the need for systematic diagnostic approaches in MINOCA.
- To underscore the uncertainty in optimal secondary prevention strategies and the need for dedicated clinical trials.
Main Methods:
- Invasive coronary angiography.
- Multivessel intracoronary imaging.
- Provocative testing for coronary artery spasm.
- Cardiac magnetic resonance imaging.
Main Results:
- Pathogenesis of MINOCA is diverse, including atherosclerosis, thrombosis, and coronary artery spasm.
- A combination of invasive angiography, intracoronary imaging, spasm testing, and cardiac MRI yields the highest diagnostic accuracy.
- Current secondary prevention guidelines are based on MI-CAD, leaving MINOCA management uncertain.
Conclusions:
- Systematic diagnostic strategies are crucial for identifying the underlying cause of MINOCA.
- Optimal medical management for MINOCA requires further investigation.
- Urgent need for clinical trials to establish evidence-based treatments for MINOCA patients.
Keywords:
MINOCAcoronary spasmmyocardial infarctionmyocardial injurynonobstructive coronary arteriestakotsubo syndromeMore Related Videos
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