Contemporary Diagnosis and Management of Patients with MINOCA

Author:

Parwani PurviORCID,Kang Nicolas,Safaeipour Mary,Mamas Mamas A.,Wei Janet,Gulati Martha,Naidu Srihari S.,Merz Noel Bairey

Abstract

Abstract Purpose of Review Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%. MINOCA is diagnostically challenging and complex, making it difficult to manage effectively. This condition accounts for 6–8% of all MI and poses an increased risk of morbidity and mortality after diagnosis. Prompt recognition and targeted management are essential to improve outcomes and our understanding of this condition, but this process is not yet standardized. This article offers a comprehensive review of MINOCA, delving deep into its unique clinical profile, invasive and noninvasive diagnostic strategies for evaluating MINOCA in light of the lack of widespread availability for comprehensive testing, and current evidence surrounding targeted therapies for patients with MINOCA. Recent Findings MINOCA is not uncommon and requires comprehensive assessment using various imaging modalities to evaluate it further. Summary MINOCA is a heterogenous working diagnosis that requires thoughtful approach to diagnose the underlying disease responsible for MINOCA further.

Funder

Loma Linda University

Publisher

Springer Science and Business Media LLC

Subject

Cardiology and Cardiovascular Medicine

Reference69 articles.

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3. •• Tamis-Holland JE, Jneid H, Reynolds HR, et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019;139(18):E891-E908. https://doi.org/10.1161/CIR.0000000000000670/FORMAT/EPUB. This study is important because it was the first scientific statement from AHA that described the diagnostic approach to patients presenting with MINOCA.

4. • Pasupathy S, Lindahl B, Litwin P, et al. Survival in patients with suspected myocardial infarction with nonobstructive coronary arteries: a comprehensive systematic review and meta-analysis from the MINOCA global collaboration. Circ Cardiovasc Qual Outcomes. 2021;14(11):e007880. https://doi.org/10.1161/CIRCOUTCOMES.121.007880/FORMAT/EPUB. This study is important because it shows that MINOCA, a condition previously dismissed as benign, has increased risk of adverse outcomes compared to healthy subjects but had a favorable prognosis compared to MI-CAD.

5. Agewall S, Beltrame JF, Reynolds HR, et al. Current opinion ESC working group position paper on myocardial infarction with non-obstructive coronary arteries on behalf of the WG on Cardiovascular Pharmacotherapy. https://doi.org/10.1093/eurheartj/ehw149.

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