Myocardial infarction with nonobstructive coronary arteries: from pathophysiology to therapeutic strategies.
Alberto FoàLisa CantonFrancesca BodegaLuca BergamaschiPasquale PaolissoAntonio De VitaAngelo VillanoAnna Vittoria MattioliIsabella TrittoDoralisa MorroneGaetano Antonio LanzaCarmine PizziPublished in: Journal of cardiovascular medicine (Hagerstown, Md.) (2023)
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by clinical evidence of acute myocardial infarction (AMI) with normal or near-normal coronary arteries on coronary angiography (stenosis < 50%) and without an over the alternative diagnosis for the acute presentation. Its prevalence ranges from 6% to 11% among all patients with AMI, with a predominance of young, nonwhite females with fewer traditional risks than those with an obstructive coronary artery disease (MI-CAD). MINOCA can be due to either epicardial causes such as rupture or fissuring of unstable nonobstructive atherosclerotic plaque, coronary artery spasm, spontaneous coronary dissection and cardioembolism in-situ or microvascular causes. Besides, also type-2 AMI due to supply-demand mismatch and Takotsubo syndrome must be considered as a possible MINOCA cause. Because of the complex etiology and a limited amount of evidence, there is still some confusion around the management and treatment of these patients. Therefore, the key focus of this condition is to identify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, echocardiography, and coronary angiography represent the first-level diagnostic investigations, but coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offer additional information to understand the underlying cause of MINOCA. Although the prognosis is slightly better compared with MI-CAD patients, MINOCA is not always benign and depends on the etiopathology. This review analyzes all possible pathophysiological mechanisms that could lead to MINOCA and provides the most specific and appropriate therapeutic approach in each scenario.
Keyphrases
- coronary artery disease
- coronary artery
- acute myocardial infarction
- percutaneous coronary intervention
- left ventricular
- magnetic resonance imaging
- end stage renal disease
- ejection fraction
- aortic stenosis
- cardiovascular events
- pulmonary artery
- coronary artery bypass grafting
- newly diagnosed
- chronic kidney disease
- high resolution
- computed tomography
- heart failure
- peritoneal dialysis
- cardiovascular disease
- healthcare
- health information
- magnetic resonance
- case report
- social media
- liver failure
- respiratory failure
- fluorescence imaging
- smoking cessation
- middle aged