Key result
MINOCA is a heterogeneous syndrome evident in up to 15% of acute myocardial infarctions, disproportionately affecting females, and requires multimodality imaging to determine the underlying etiology.
Why the study?
MINOCA is an often-overlooked syndrome with a broad differential diagnosis and serious prognosis requiring a standardized multimodality approach to identify underlying etiology and direct treatment.
MINOCA is a complex syndrome requiring a standardized diagnostic approach, including multimodality imaging and coronary reactivity testing, to determine the underlying etiology and guide appropriate treatment.
Answers are grounded in this paper and cite their sources.
Clinicians should pursue standardized MINOCA evaluation; supports calls for improved recognition and targeted trials.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is evident in up to 15% of all acute myocardial infarctions (AMI) and disproportionally affects females. Despite younger age, female predominance, and fewer cardiovascular risk factors, MINOCA patients have a worse prognosis than patients without cardiovascular disease and a similar prognosis compared to patients with MI and obstructive coronary artery disease (CAD). MINOCA is a syndrome with a broad differential diagnosis that includes both ischemic [coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), and coronary embolism/thrombosis] and non-ischemic mechanisms (Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy)-the latter called MINOCA mimickers. Therefore, a standardized approach that includes multimodality imaging, such as coronary intravascular imaging, cardiac magnetic resonance, and in selected cases, coronary reactivity testing, including provocation testing for coronary vasospasm, is necessary to determine underlying etiology and direct treatment. Herein, we review the prevalence, characteristics, prognosis, diagnosis, and treatment of MINOCA -a syndrome often overlooked.
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Yildiz et al. (2022) conducted a review in Myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA is a heterogeneous syndrome evident in up to 15% of acute myocardial infarctions, disproportionately affecting females, and requires multimodality imaging to determine the underlying etiology.
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