This editorial discusses the clinical definition and management of myocardial infarction with nonobstructive coronary arteries (MINOCA).
This editorial highlights the clinical importance of MINOCA and introduces a major study on its management strategies.
Article, see p 1481 M yocardial infarction with nonobstructive coronary arteries (MINOCA) is clinically defined by the presence of the universal acute myocardial infarction (AMI) criteria, absence of obstructive coronary artery disease (50% stenosis), and no overt cause for the clinical presentation at the time of angiography (eg, classic features for takotsubo cardiomyopathy). 1 With the more frequent contemporary use of coronary angiography in AMI, clinicians have been regularly confronted with this puzzling problem and seeking guidance in its management. An article by Lindahl et al 2 in this issue of Circulation represents a major step forward in MINOCA and thereby warrants taking stock of the past, present, and future management strategies of this intriguing condition.
“As an interventional cardiologist, it's not uncommon for me to see patients come to the cath lab with signs and symptoms of a heart attack who have elevation in the enzymes, and then when they get the cardiac cath, they'll have nonobstructive disease or normal coronaries. Then later on you'll hear the house staff tell the patient: 'Oh everything's fine, you don't need anything, go home.'”
Pasupathy et al. (2017) conducted an editorial in Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA). This editorial discusses the clinical definition and management of myocardial infarction with nonobstructive coronary arteries (MINOCA).