Myocardial infarction with non-obstructive coronary arteries

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis in about 10% of cases presenting with symptoms suggestive of acute myocardial ischaemia and no significant atherosclerotic plaques in coronary angiography. It is a heterogenous clinical entity with a complex aetiology and always requires a challenging work-up. The final diagnosis may confirm any coronary pathology (dissection, spasm, thrombus) or significantly differ from the previous one (myocarditis, takotsubo cardiomyopathy). This paper focuses on the current knowledge on MINOCA, guidelines on the management of patients, and indicates new research areas to further elucidate this issue. The most important message is that MINOCA is a serious condition with outcomes at least as serious as in myocardial infarction resulting from coronary atherosclerosis. Streszczenie Zawał serca bez istotnych zmian w nasierdziowych tętnicach wieńcowych (MINOCA) to robocze rozpoznanie ustalane w ok. 10% przypadków, w których w koronarografii nie stwierdza się istotnych zwężeń miażdżycowych, a objawy kliniczne silnie sugerują podłoże niedokrwienne. Choroba stanowi istotne wyzwanie diagnostyczne ze względu na heterogenną etiologię i zawsze wymaga uważnego podejścia. Ostateczna diagnoza może potwierdzić przyczynę wieńcową (dysekcja, skurcz, zakrzep) lub znacznie różnić się od wstępnego rozpoznania (zapalenie mięśnia serca, kardiomiopatia takotsubo). W artykule przedstawiono zarys współczesnej wiedzy na temat MINOCA, obowiązujące zalecenia dotyczące diagnostyki i terapii oraz wskazano nowe kierunki badań niezbędnych do pełnego wyjaśnienia tego zagadnienia. Najważniejszym przesłaniem pracy jest wniosek, że mimo braku zwężeń w tętnicach wieńcowych MINOCA jest zespołem chorobowym o rokowaniu co najmniej tak poważnym jak w zawale serca o podłożu miażdżycowym.

The impact of ECG at admission and a culprit lesion on 12-month outcomes in acute myocardial infarction – analysis based on the PL-ACS Registry

“…Our study proved that the long-term prognosis in NIC patients is not favourable. Twelve-month mortality is higher than for TWI, and even for STE [4,10]. Analysis of independent predictors of long-term mortality revealed that a lack of ischaemic abnormalities has the same impact as ST-segment elevation and T-wave inversion [12].…”

“…Final confirmation of type 1 myocardial infarction and revealing of a culprit lesion base on a coronary angiography [9]. In routine medical practice, one might also encountered patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) [10].…”

Paroxysmal Sustained Ventricular Tachycardia with Cardiac Arrest and Myocardial Infarction in 29-Year-Old Man Addicted to Medical Marijuana—It Never Rains but It Pours

“…Importantly, myocardial infarction with non-obstructive coronary arteries (MINOCA) is a disease syndrome with a prognosis at least as serious as an atherosclerotic myocardial infarction. Additionally, the final diagnosis of MINOCA causes may confirm the coronary cause (dissection, spasm, thrombus) or differ significantly from the initial diagnosis (myocarditis, takotsubo cardiomyopathy, use of stimulants) [ 30 , 31 ]. At times, the primary mechanism cannot be identified and documented like in our case.…”

Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

“…The pathophysiology of MINOCA / INOCA is complex with several possible underlying mechanisms [2,[4][5][6]. Patients with MINOCA are usually younger and more often females; however, the distribution of the traditional cardiovascular risk factors and comorbidities varies between analyses [5,[7][8][9].…”