Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity that is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). Major advances in understanding this condition have been made in recent years. The precise pathogenesis is poorly understood and is being studied and examined further. Guidelines indicate that MINOCA is a group of heterogeneous diseases with different mechanisms of pathology. Since there are multiple possible pathological mechanisms, it is not certain that the classical secondary prevention and treatment strategy for MI with obstructive coronary artery disease (MI-CAD) is optimal for MINOCA patients. The prognosis and predictors for MINOCA patients remain unclear. Although the prognosis is slightly better for MINO-CA patients than for MI-CAD patients, MINOCA isn't always benign. The aim of this paper was to review the literature and evaluate MINOCA epidemiology, clinical features, etiology, diagnosis, treatment, and prognosis.

Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction

“…Enormous studies are dedicated to the issue of MI occurrence in IHD patients, particularly early MI diagnostic [15][16][17][18][19]. However, there is limited data regarding risk factors for UA transformation toward MI [20].…”

Myocardial Infarction with Nonobstructive Coronary Arteries: A Diagnostic Challenge

“…Atrial fibrillation is the commonest embolic cause of MINOCA 7 (accounting for up to 3% of cases 2 ) and an independent risk factor. 6 10 Patients with metallic mitral valves and atrial fibrillation are regarded high risk for cardioembolism, warranting a target INR of at least 3, whereas those with no risk factors have a target of 2.5. 11 Her INR at presentation was therefore subtherapeutic ( Table 1 ) and could have been responsible for the event.…”

“… 2 Among patients with MI, it has been found that up to 10 to 15% have normal coronary arteries on angiography. 1 3 4 5 6 This results in a diagnosis of MI with nonobstructive coronary arteries (MINOCA). MINOCA is a working diagnosis 3 4 5 6 7 8 with a predilection for younger non-white women (younger than 55 years) without traditional cardiovascular risk factors.…”

“… 1 3 4 5 6 This results in a diagnosis of MI with nonobstructive coronary arteries (MINOCA). MINOCA is a working diagnosis 3 4 5 6 7 8 with a predilection for younger non-white women (younger than 55 years) without traditional cardiovascular risk factors. 1 2 3 4 7 Diagnosis requires the following 2 4 6 8 :…”

“… 5 MINOCA is heterogenic and warrants further investigation. 1 2 3 5 6 7 Performance of these tests is limited by availability, cost, and expertise, 1 particularly in developing economies.…”