Key result
Invasive functional assessment of epicardial and microvascular coronary circulation is critical to identify the underlying pathophysiological mechanisms of MINOCA and guide etiology-based therapy.
Why the study?
MINOCA encompasses several incompletely understood pathophysiological mechanisms, and routine physiological assessment is not recommended by guidelines despite evidence supporting its role in guiding therapy.
Routine invasive physiological assessment in MINOCA patients is essential for identifying the underlying mechanism (e.g., microvascular dysfunction, vasospasm) and guiding personalized therapy, despite current guidelines not recommending it.
Answers are grounded in this paper and cite their sources.
Further trials needed before routine MINOCA assessment; leaves open whether physiology-guided therapy improves outcomes.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) encompasses several pathophysiological mechanisms not yet fully understood. Among the latter, vasomotion abnormalities and coronary microvascular dysfunction (CMD) play a major role for both epidemiological and prognostic reasons. Despite current guidelines do not recommend routine physiological assessment of both epicardial and microvascular coronary compartments within the context of an acute myocardial infarction, several recent evidence support the critical role of a comprehensive invasive functional assessment in order to identify the underlying pathophysiological mechanism and consequently to select an appropriate therapeutic strategy. Unfortunately, optimal medical therapy for these patients is not currently established due to the lack of dedicated trials evaluating clinical outcomes of commonly used medications for secondary prevention in MINOCA patients. For this reason, additional research is warranted to provide personalized treatments for patients affected by this puzzling clinical entity.
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Mangiacapra et al. (2021) conducted a review in Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA). Invasive functional assessment was evaluated. Invasive functional assessment of epicardial and microvascular coronary circulation is critical to identify the underlying pathophysiological mechanisms of MINOCA and guide etiology-based therapy.
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