Contemporary Diagnosis and Management of Patients with MINOCA

Abstract

Purpose of Review Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%. MINOCA is diagnostically challenging and complex, making it difficult to manage effectively. This condition accounts for 6–8% of all MI and poses an increased risk of morbidity and mortality after diagnosis. Prompt recognition and targeted management are essential to improve outcomes and our understanding of this condition, but this process is not yet standardized. This article offers a comprehensive review of MINOCA, delving deep into its unique clinical profile, invasive and noninvasive diagnostic strategies for evaluating MINOCA in light of the lack of widespread availability for comprehensive testing, and current evidence surrounding targeted therapies for patients with MINOCA. Recent Findings MINOCA is not uncommon and requires comprehensive assessment using various imaging modalities to evaluate it further. Summary MINOCA is a heterogenous working diagnosis that requires thoughtful approach to diagnose the underlying disease responsible for MINOCA further.

Acute myocardial infarction without obstructive lesions, a retrospective study in older adult patients in a Latin American hospital.

“…When analyzing the existing body of scientific research, the long-term effects are not clearly known (18). Furthermore, regarding secondary prevention, the research conducted thus far has not yielded conclusive scientific proof of the molecules that could be advantageous for these individuals; this is one of the aspects that will be examined in the years to come (19).Although other investigations (10) did not find any changes in the outcomes between the groups with or without ST elevation following a 4-year follow-up, we are unable to assess this association because our study is retrospective in nature. As one of the pillars to be taken into consideration for later phases, we must also bring up the article (18), in which the authors developed a risk score to predict MINOCA in patients with STEMI generally.…”

“…SCA type II, for example, is sometimes misdiagnosed as a non-obstructive lesion that results in MINOCA. Twenty percent or so of MINOCA patients had acute coronary syndrome (10). About 25% of women with acute coronary syndromes under 50 years old have ACS, which is more frequent in women than in males (11).…”

Acute Coronary Syndrome with Non-Obstructive Plaque on Angiography and Features of Vulnerable Plaque on Intracoronary Optical Coherence Tomography

“…When used early in the diagnosis of MINOCA, CMR can exclude myocarditis, takotsubo and other cardiomyopathies, as well as provide imaging confirmation of myocardial infarction [30,31]. However, CMR does not always uncover the cause of MINOCA, as in cases of absent or unavailable subendocardial or transmural ischemic late-gadolinium enhancement patterns, and will thus require further intravascular imaging [32]. Therefore, multimodality imaging with coronary OCT and CMR has recently been recommended for the diagnosis of MINOCA [23].…”

Health position paper and redox perspectives on reactive oxygen species as signals and targets of cardioprotection

“…More recently, awareness has increased that also coronary microvascular disease in the absence of significant epicardial coronary obstruction can initiate acute myocardial infarction, and this occurs more frequently in women than in men [ 110 , 111 ]. Such coronary microvascular disease is characterized by endothelial dysfunction, enhanced vasoconstrictor responsiveness and reduced coronary dilator reserve on an adenosine challenge, and it is diagnosed by a combination of imaging procedures [ 111 , 112 ]. The role of the coronary circulation as a victim of myocardial I/R has long been neglected but is now clear and receiving increasing attention [ 113 , 114 ].…”