Coronary artery thromboembolism as a cause of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Ceasovschih, Alexandr; Mantzouranis, Emmanouil; Dimitriadis, Kyriakos; Sorodoc, Victorita; Vlachakis, Panayotis K.; Karanikola, Aikaterini-Eleftheria; Theofilis, Panagiotis; Koutsopoulos, George; Drogkaris, Sotirios; Andrikou, Ioannis; Valatsou, Angeliki; Lazaros, George; Sorodoc, Laurentiu; Tsioufis, Konstantinos

doi:10.1016/j.hjc.2024.05.001

Hellenic Journal of Cardiology

2024

DOI: 10.1016/j.hjc.2024.05.001

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Coronary artery thromboembolism as a cause of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Alexandr Ceasovschih,

Emmanouil Mantzouranis,

Kyriakos Dimitriadis

et al.

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2024

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Cited by 3 publications

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MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

Khattab,

Karelas,

Pallas

et al. 2024

Biomedicines

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity characterized by the absence of significant coronary artery obstruction in epicardial arteries (<50%) on coronary angiography in the setting of acute myocardial infarction (AMI). This article aims to provide a narrative review of the pathophysiological mechanisms, diagnostic challenges, and prognosis associated with MINOCA based on pathophysiology regarding the atherosclerotic and non-atherosclerotic causes. Etiological factors, including thromboembolism, coronary artery spasm, spontaneous coronary artery dissection, coronary microvascular disease, and supply–demand mismatch, are addressed. Imaging modalities such as echocardiography, advances in coronary angiography like intravascular ultrasound (IVUS) and optical coherence tomography (OCT), cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) are also analyzed. MINOCA patients have a better short-term prognosis compared to those with obstructive coronary artery disease but face significant long-term risks, underscoring the need for precise diagnosis and management strategies. Elevated inflammatory markers and specific genetic predispositions are also associated with adverse outcomes in MINOCA. This review focused on MINOCA from a pathophysiological perspective on the diverse underlying mechanisms, the challenges in achieving accurate diagnosis, the importance of a tailored therapeutic approach and the necessity for further investigation of clinical outcomes.

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MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

Khattab,

Karelas,

Pallas

et al. 2024

Biomedicines

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Enhanced Hypercoagulability Using Clot Waveform Analysis in Patients with Acute Myocardial Infarction and Acute Cerebral Infarction

Masuda,

Wada,

Kato

et al. 2024

JCM

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Background: Routine activated partial thromboplastin time (APTT) and prothrombin time (PT) measurements do not indicate hypercoagulability in patients with acute myocardial infarction (AMI) and acute cerebral infarction (ACI). Methods: Hypercoagulability in patients with AMI or ACI was evaluated using a clot waveform analysis of the APTT or a small amount of tissue factor activation assay (sTF/FIXa). In the CWA, the derivative peak time (DPT), height (DPH), width (DPW), and area the under the curve (AUC) were evaluated. Results: The APTT did not indicate hypercoagulability, but the second DPT of CWA-sTF/FIXa was significantly shorter in patients with ACI than in healthy volunteers (HVs). The first DPH values of CWA-APTT and CWA-sTF/FIXa in patients with ACI and AMI were significantly higher than in HVs. In the receiver operating characteristic (ROC) analyses of ACI or AMI vs. non-thrombosis, the AUC was >0.800 in the DPHs of CWA-APTT and CWA-sTF/FIXa. The AUC of CWA-APTT and CWA-sTF/FIXa in patients with AMI and ACI was significantly higher than in HVs. The AUC/second DPT of CWA-APTT and CWA-sTF/FIXa in patients with AMI and ACI was significantly higher than in HVs. Regarding the ROC analyses of ACI or AMI vs. HVs, the AUC of ROC was higher than 0.800 in the AUC and AUC/second DPT of CWA-APTT and CWA-sTF/FIXa. Conclusions: The AUC/second DPT of CWA-APTT and CWA-sTF/FIXa may be a useful parameter for detecting a hypercoagulable state in patients with AMI and ACI.

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Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA): A Case Report and Comprehensive Discussion of Pathophysiology and Risk Factors

Borkowski,

Maliha,

Borkowski

et al. 2024

Cureus

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Coronary artery thromboembolism as a cause of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Cited by 3 publications

References 146 publications

MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

Enhanced Hypercoagulability Using Clot Waveform Analysis in Patients with Acute Myocardial Infarction and Acute Cerebral Infarction

Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA): A Case Report and Comprehensive Discussion of Pathophysiology and Risk Factors

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