Key result
MINOCA occurs in ~7% of spontaneous MIs referred for angiography and requires systematic diagnosis.
Why the study?
Current secondary prevention guidelines are largely based on data from patients with obstructive CAD, leaving optimal medications after MINOCA uncertain.
MINOCA is a distinct subtype of MI requiring systematic multimodality diagnostic approaches, with a current lack of evidence-based secondary prevention therapies.
MINOCA warrants systematic multimodality evaluation in MI; leaves open evidence-based secondary prevention pending dedicated trials.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an important subtype of myocardial infarction (MI) that occurs in approximately 6-8% of patients with spontaneous MI who are referred for coronary angiography. MINOCA disproportionately affects women, but men are also affected. Pathogenesis is more variable than in MI with obstructive coronary artery disease (MI-CAD). Dominant mechanisms include atherosclerosis, thrombosis, and coronary artery spasm. Management of MINOCA varies based on the underlying mechanism of infarction. Therefore, systematic approaches to diagnosis are recommended. The combination of invasive coronary angiography, multivessel intracoronary imaging, provocative testing for coronary spasm, and cardiac magnetic resonance imaging provides the greatest diagnostic yield. Current clinical practice guidelines for the secondary prevention of MI are based largely on data from patients with MI-CAD. Thus, optimal medications after MINOCA are uncertain. Clinical trials focused on the treatment of patients with MINOCA are urgently needed to define optimal care.
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Reynolds et al. (2022) conducted a review in Myocardial infarction with nonobstructive coronary arteries (MINOCA). Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in approximately 6-8% of patients with spontaneous MI referred for coronary angiography and requires systematic diagnosis.
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