[Myocardial Infarction with no obstructive coronary arteries: Imaging plays a central role]

Area of Science:

• Cardiology
• Internal Medicine

Context:

• Myocardial infarction with non-obstructive coronary lesion (MINOCA) accounts for approximately 6% of all myocardial infarctions.
• MINOCA patients face a poor long-term prognosis with a 2% annual mortality rate.
• The heterogeneous nature of MINOCA and poorly understood pathology contribute to its high mortality.

Purpose:

• To provide an updated review on the definition, epidemiology, diagnostic strategies, and treatment options for MINOCA.
• To emphasize the importance of recognizing MINOCA and employing diagnostic strategies to identify etiological mechanisms.
• To guide clinicians in selecting appropriate treatments for MINOCA patients.

Summary:

• This review details diagnostic tools for MINOCA, including coronary angiography, coronary physiology, pharmacological testing, endo-coronary imaging, and cardiac MRI.
• It highlights the challenges in diagnosing MINOCA due to its heterogeneous nature and complex underlying pathologies.
• The review underscores the necessity of a systematic diagnostic approach to determine the specific cause of MINOCA.

Impact:

• Improved understanding and diagnosis of MINOCA can lead to more targeted and effective treatment strategies.
• Early identification of etiological mechanisms in MINOCA patients is expected to reduce the high annual mortality rate.
• This review aims to enhance clinical awareness and management protocols for MINOCA, ultimately improving patient outcomes.