Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA): a Review of the Present and Preview of the Future

Abstract

Purpose of Review The syndrome of myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is not uncommon and has multiple potential coronary etiologies. With the use of more sensitive cardiac biomarkers and advanced cardiovascular imaging, MINOCA presentations have gain increasing attention among researchers and cardiologists. Despite the presence of a myocardial infarction and elevated future risk, many patients are sent home with little or no cardio-protective treatment and no explanation for their symptoms. In this review, we emphasized the importance of MINOCA treatment based on the underlying etiology. Recent Findings As there are multiple pathophysiological mechanisms potentially involved in MINOCA, it should be considered a working diagnosis until there is a better understanding regarding the underlying cause. It is critical to use multimodality imaging when treating patients with MINOCA to help determine the underlying etiology and rule out mimics of MINOCA, so that therapies appropriate to the etiology can be provided. Summary A more systematic approach to managing patients with MINOCA should result in better treatment and an improved prognosis for these patients.

Cardiac magnetic resonance findings in acute and post‐acute COVID‐19 patients with suspected myocarditis

“…Myocardial infarction was the second most frequent cause of AMCovS in our cohort, accounting for 24% of patients, with larger scars in patients with obstructive CAD than in patients with non‐obstructive CAD (35% and 11% vs 5% and 1%, respectively), similarly to what is observed in non‐COVID‐19 setting. 25 …”

“…24 Myocardial infarction was the second most frequent cause of AMCovS in our cohort, accounting for 24% of patients, with larger scars in patients with obstructive CAD than in patients with nonobstructive CAD (35% and 11% vs 5% and 1%, respectively), similarly to what is observed in non-COVID-19 setting. 25 Acute myocardial injury is reported to be more frequent in ICU patients in comparison to those with mild forms of infection, as they are considered to have a 13-fold higher risk. 26 In our cohort, most patients admitted to ICU had severe pneumonia (4%, 67%), while the remaining two had cardiogenic shock but mild COVID-19 pneumonia.…”

MINOCA: Myocardial infarction no obstructive coronary artery disease

“…Plaque disruption, including plaque erosion, plaque rupture, or calcific nodules, can lead to MI-CAD if there is a complete or near complete occlusion secondary to thrombosis. However, if the thrombosis is not significant enough to cause an obstructive lesion, MINOCA will result [ 9 ]. As well as these underlying causes, there are also conditions that are not a MI, but mimic MINOCA.…”

Coronary functional assessment in non-obstructive coronary artery disease: Present situation and future direction

“…The potential underlying pathophysiological mechanisms for MINOCA include: (1) atherosclerotic causes of myocardial necrosis, including plaque rupture, plaque erosion, and calcific nodules, collectively referred to as plaque disruption; (2) non-atherosclerotic causes, such as epicardial coronary vasospasm, coronary microvascular dysfunction, coronary embolism/thrombosis, and spontaneous coronary artery dissection ( 8 , 15 ).…”