Key result
Myocardial infarction with nonobstructive coronary arteries accounts for approximately 6% of all myocardial infarctions and requires specific diagnostic evaluation to determine the underlying etiology.
Why the study?
MINOCA represents almost 6% of all MI cases and requires diagnostic specification, yet commonly accepted treatment guidelines consistent with current ideas are not available.
MINOCA is a working and final diagnosis that requires multimodality imaging (MRI, OCT, IVUS) to identify the specific underlying etiology for tailored management.
The review focused on a relatively new issue, myocardial infarction with non-obstructive coronary arteries (MINOCA). According to current ideas, almost 6% of all myocardial infarction (MI) cases may be MINOCA. This term can be used both as a "working diagnosis" at the time of further evaluation and a final diagnosis after establishing a cause for each specific case. Since some variants of cardiac, including non-coronary, pathology may be similar to MI in a number of signs, each individual case of MINOCA requires specification. Among major causes for this condition are vasospasm, CA embolism, spontaneous CA dissection, rupture of an eccentric atherosclerotic plaque in a CA, etc. Diagnostics of MINOCA includes both a set of diagnostic tests for verification of the MI diagnosis according to the Fourth Universal Definition of MI and specific studies for elaboration of the disease etiology. A special role in differential diagnostics belongs to gadolinium-enhanced magnetic-resonance imaging (MRI) of the myocardium, which allows to distinguish between MI and non-ischemic myocardial injury of different genesis. Methods of intravascular visualization, such as optical coherence tomography (OCT) and intravascular ultrasound are also important. Commonly accepted guidelines on the treatment of this pathology consistent with current ideas are not available. However, it is obvious that therapeutic possibilities and prognosis for MINOCA depend on the identified cause in each individual case.
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Sherashov et al. (2020) conducted a review in Myocardial infarction with nonobstructive coronary arteries (MINOCA). Diagnostic and therapeutic strategies for MINOCA was evaluated. Myocardial infarction with nonobstructive coronary arteries accounts for approximately 6% of all myocardial infarctions and requires specific diagnostic evaluation to determine the underlying etiology.
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