Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Abstract

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.

Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers

“…Coronary intravascular imaging is another important tool in determining the underlying diagnosis of MINOCA, but it was not used at any of the study sites. Our findings support the need for standardized algorithms in the diagnosis of STEMI presenting with MINOCA that includes the use of CMRI in all cases …”

“…Our findings support the need for standardized algorithms in the diagnosis of STEMI presenting with MINOCA that includes the use of CMRI in all cases. 29,30 Notably, we documented that patients with MINOCA and MINOCA mimickers presenting with STEMI were less likely to be prescribed cardiac medications upon discharge compared with obstructive disease, similar to the treatment disparities reported in MINOCA cohorts presenting with NSTEMI. 31,32 Patients with MINOCA likely receive suboptimal treatment for several reasons: (1) the popular misconception that MINOCA cases are often false positive troponins; (2) lack of recognition that a MINOCA event is associated with poor outcomes; (3) diversity in the range of underlying diagnoses that cause MINOCA (plaque disruption, coronary vasospasm, and embolism); and (4) limited knowledge regarding effective treatments for MINOCA.…”

Association of Depression with Myocardial Infarction with Non-Obstructive Coronary Arteries: A Systematic Review

“… 15 Other factors that may contribute to MINOCA include vasospasm, embolism, and underlying conditions such as coronary artery spasm, spontaneous coronary artery dissection, or takotsubo cardiomyopathy. 16 – 18 Overall, MINOCA is a complex and multifactorial condition, and further research is needed to fully understand the mechanisms underlying its development and to develop effective treatment strategies.…”

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

“…A HAS e os riscos dietéticos lideram o ranking dos FR atribuíveis a DIC, em ambos os sexos, mundialmente. 28 No estudo caso-controle derivado do estudo VIRGO, com 2.264 pacientes com IAM (18-55 anos) e 2.264 controles pareados, 3.122 (68,9%) eram mulheres, com mediana de idade de 48 (44)(45)(46)(47)(48)(49)(50)(51)(52) O reconhecimento de FR tradicionais para a DCV aterosclerótica, bem como de FR emergentes e não tradicionais únicos ou mais frequentes nas mulheres, e de seus diferentes impactos contribui para o novo entendimento dos mecanismos que levam aos piores desfechos nas mulheres (Figura 3.1). Maior detalhamento sobre a importância dos FR no sexo feminino pode ser visto no capítulo subsequente.…”

“…A manifestação funcional está relacionada ao acoplamento cardíaco-coronário ineficiente, resultado do aumento do tônus microvascular durante pico do exercício e durante o repouso, levando a uma maior demanda de oxigênio do miocárdio no cenário de reserva vasodilatadora esgotada saturada. 48,52 Vários estudos demonstraram diferenças relacionadas ao sexo na resposta aos testes funcionais, indicando que as mulheres apresentam mais disfunção microvascular coronariana e vasoespasmo epicárdico em comparação com os homens. 53…”