Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients

Abstract

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) represents a significant proportion (up to 15%) of acute myocardial infarction (AMI) population. MINOCA is diagnosed in patients who fullfilled the fourth universal definition of AMI in the absence of significant obstructive coronary artery disease on coronary angiography. MINOCA is a group of heterogeneous diseases with different pathophysiological mechanisms requiring multimodality imaging. Left ventriculography, cardiac magnetic resonance imaging and intra-coronary imaging (IVUS, OCT) are useful tools playing a pivotal role in the diagnostic work-up. There are no standard guidelines on the management of MINOCA patients and the therapeutic approach is personalized, thereby detecting the underlying aetiology is fundamental to initiate an early appropriate cause-targeted therapy.

Fenótipos MINOCA – Um Desafio para o Manejo Específico do Paciente

“…Como a MINOCA envolve vários mecanismos fisiopatológicos e várias apresentações clínicas, o tipo de manejo varia dependendo da causa básica. 3 O diagnóstico diferencial inclui miocardite, doença microvascular coronariana, embolia pulmonar, doenças do miocárdio como Takotsubo e desequilíbrio entre oferta e demanda de oxigênio do miocárdio (IM tipo 2). 4 Apesar de ter uma declaração de posição contemporânea da ESC e da AHA, existe grande variabilidade na forma como os pacientes com suspeita de MINOCA são avaliados.…”

“…Since MINOCA involves several pathophysiological mechanisms and various clinical presentations, the type of management varies depending on the underlying cause. 3 The differential diagnosis includes myocarditis, coronary microvascular disease, pulmonary embolism, myocardial diseases such as Takotsubo, and an imbalance between oxygen supply and demand of myocardium (Type 2 MI). 4 Despite having a contemporary position statement from the ESC and the AHA, great variability exists in how patients with suspected MINOCA are evaluated.…”

Práticas Clínicas Aplicadas a Pacientes Com Infarto Do Miocárdio Sem Obstrução De Artéria Coronária (Minoca)

“…As principais podem ser divididas entre causas isquêmicas e não isquêmicas. (1,2,3) No que se refere às suas características epidemiológicas, são observadas divergências daquelas encontradas no IAM por obstrução aterosclerótica. Observou-se um acometimento maior em pessoas do sexo feminino, não brancas e mais jovens, com menos de 55 anos.…”

Protective Effects of Ultrasound-Based Preoperative Exogenous Sacubitril/Valsartan on the Heart and Kidney of Patients Undergoing Percutaneous Coronary Intervention

“…This method has a good disease diagnosis effect, is noninvasive and simple, has a high resolution, and makes the cardiac structure and blood vessels clearer and more intuitive. It can markedly improve the diagnostic accuracy of patients and has been widely recognized in clinical practice [10,11]. Most patients with AMI need coronary intervention, and intervention treatment will cause a certain degree of damage to vascular endothelial cells and adverse effects on the tissue cells of patients, causing myocardial necrosis of patients and even heart failure, which has an adverse effect on the prognosis of coronary intervention.…”