Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA)

Pirozzolo, Giancarlo; Seitz, Andreas; Athanasiadis, Anastasios; Bekeredjian, Raffi; Sechtem, Udo; Ong, Peter

doi:10.1007/s00392-019-01507-w

Cited by 46 publications

(34 citation statements)

References 18 publications

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“…The results of functional testing at the epicardial level were coupled with microcirculation interrogation in only 3 studies included in our review. Overall, microvascular dysfunction was found in one third of the 456 patients with MINOCA investigated by Montone et al [30], Pirozzolo et al [31], and Bil et al [32].…”

Section: Assessment In the Acute Phasementioning

confidence: 92%

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Pelliccia

Pepine

Berry

et al. 2021

International Journal of Cardiology

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The role of cardiac magnetic resonance (CMR) in identifying mechanisms for myocardial infarction with nonobstructed coronary arteries (MINOCA) is well established. Recent reports have highlighted the potentially key role of invasive management in this diagnostic process. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) allow precise evaluation of coronary anatomy, and assessment of coronary physiology in the catheter laboratory provides information on the hemodynamic significance of sub-critical atherosclerosis and on coronary microvascular dysfunction (CMD). We reviewed the evidence for the contribution of invasive diagnostic techniques in identifying provisional causes for MINOCA. Overall, among 82 studies including 8457 patients were selected. In the acute phase, 16 studies with IVUS or OCT (1207 patients) disclosed that plaque disruption and spontaneous coronary artery dissection had a pooled prevalence of 38% (95% confidence intervals (CI): 29% to 51%) and 16% (95% CI: 9% to 27%), respectively. In 18 studies, coronary function testing (1449 patients) showed a pooled prevalence of spontaneous and/or provoked epicardial coronary spasm of~28% (95% CI:17% to 41%). In 3 studies (456 patients), the pooled prevalence of CMD was 32% (95% CI: 20% to 49%). In the subacute phase, 42 CMR studies (5821 patients) showed that a pooled prevalence of myocarditis, takotsubo syndrome and cardiomyopathy of 26% (95% CI: 12% to 40%), 11% (95% CI: 5% to 25%), and 7% (95% CI: 1% to 19%), respectively. In 12 studies on thrombophilia screening (n = 834), the pooled prevalence of thrombotic disorder was~11% (95% CI: 7%% to 25%). In conclusion, the pathophysiology of MINOCA can be established in the majority of cases using both invasive and non-invasive tools to provide direction for appropriate management.

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Section: Assessment In the Acute Phasementioning

confidence: 92%

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Pelliccia

Pepine

Berry

et al. 2021

International Journal of Cardiology

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“…Recurrent episodes of rest angina with circadian pattern that respond to nitrates are in favor of vasospasm [88]. Inducible major epicardial coronary spasm was revealed in 43 to 54% of MINOCA patients [89,90] (Fig. 4).…”

Section: Management Of Patients Suspected Of Minocamentioning

confidence: 98%

Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients

Matta¹,

Nader²,

Roncalli³

2021

Reviews in Cardiovascular Medicine

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Myocardial infarction with non-obstructive coronary artery disease (MINOCA) represents a significant proportion (up to 15%) of acute myocardial infarction (AMI) population. MINOCA is diagnosed in patients who fullfilled the fourth universal definition of AMI in the absence of significant obstructive coronary artery disease on coronary angiography. MINOCA is a group of heterogeneous diseases with different pathophysiological mechanisms requiring multimodality imaging. Left ventriculography, cardiac magnetic resonance imaging and intra-coronary imaging (IVUS, OCT) are useful tools playing a pivotal role in the diagnostic work-up. There are no standard guidelines on the management of MINOCA patients and the therapeutic approach is personalized, thereby detecting the underlying aetiology is fundamental to initiate an early appropriate cause-targeted therapy.

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“…Previous studies have shown that there is evidence of microcirculatory spasm in about 16% of MINOCA patients [28]. Two studies showed that 43–54% of MINOCA patients experienced microcirculatory spasm [25, 26]. The above symptoms can be reproduced by the intracoronary ACh test, triggering ischemic ECG changes (0.1 lower in ST-segment in at least 2 leads) without epicardial spasm (a diameter reduction >90%).…”

Section: Pathogenesis and Underlying Etiology Of Minocamentioning

confidence: 99%

“…A certain amount of ACh or ergometrine can be injected into the left and right coronary arteries for patients suspected of MINOCA, and the spasm of the coronary artery can be evaluated after 3 min by CAG. Several studies found that 43–54% of patients with MINOCA had coronary vasospasm, and it was recommended that all MINOCA patients have a coronary vasospasm provocation test [25, 26]. The diagnosis of acute pulmonary embolism should be considered in MINOCA, but the value of this diagnosis as a routine screening is not obvious.…”

Section: Clinical Assessment Of Minocamentioning

confidence: 99%

“…Montone et al [28] found that patients who had been screened for coronary spasm stimulation and received CCB had a better prognosis than the control group, i.e., CCB was a robust secondary preventive measure. CCB has been indicated for MINOCA patients with coronary spasm in other trials [26]. Coronary dissection treatment is usually accompanied by intraluminal complications.…”

Section: Current Managementmentioning

confidence: 99%

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Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

et al. 2020

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Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity that is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). Major advances in understanding this condition have been made in recent years. The precise pathogenesis is poorly understood and is being studied and examined further. Guidelines indicate that MINOCA is a group of heterogeneous diseases with different mechanisms of pathology. Since there are multiple possible pathological mechanisms, it is not certain that the classical secondary prevention and treatment strategy for MI with obstructive coronary artery disease (MI-CAD) is optimal for MINOCA patients. The prognosis and predictors for MINOCA patients remain unclear. Although the prognosis is slightly better for MINO-CA patients than for MI-CAD patients, MINOCA isn't always benign. The aim of this paper was to review the literature and evaluate MINOCA epidemiology, clinical features, etiology, diagnosis, treatment, and prognosis.

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Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA)

Cited by 46 publications

References 18 publications

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

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