Tackling MINOCA: A Comprehensive Review of its Mechanisms and Management

Patients with acute myocardial infarction (AMI) may show no blockage in their coronary arteries. This condition is known as myocardial infarction with non-obstructive coronary arteries (MINOCA). It affects between 6–8% of individuals with spontaneous MI who are referred for coronary angiography screening. The key mechanisms responsible are coronary artery spasm, thrombosis, and atherosclerosis. Identifying the underlying mechanism of infarction determines how MINOCA is managed. A systematic approach for the diagnosis is recommended. Diagnostic yield is achieved by combining cardiac magnetic resonance imaging, provocative testing for coronary spasm, multivessel intracoronary imaging, and invasive coronary angiography. Majority of the practice guidelines and treatment regimens are currently based on data from patients with MI with obstructive coronary artery disease (MI-CAD) and secondary prevention guidelines for atherosclerotic disease. The risk of long-term adverse outcomes remains high for MINOCA patients. Hence, in order to determine the best course of treatment for patients with MINOCA, more clinical trials are needed. This review emphasizes the pathophysiology of MINOCA, highlighting its various causes, challenges in diagnosis, the need for personalized treatment, and the necessity for further research on clinical outcomes.