Beyond the blockage: A review of myocardial infarction with non-obstructive coronary arteries

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome in which patients have clear signs of heart muscle injury but show <50% stenosis on coronary angiography. We recognize it as a distinct condition that demands its own diagnostic and treatment approaches. Recent studies were reviewed to elucidate the pathophysiology, diagnostic criteria, and management strategies for MINOCA. PubMed, Scopus, and Google Scholar were searched for full-text, peer-reviewed articles on MINOCA’s pathophysiology and diagnostics. Keywords such as “non-obstructive coronary artery,” “ischemic heart diseases,” and “myocardial infarction” were used. Following the screening and synthesis of the selected papers, we found that MINOCA can result from ischemic causes—plaque disruption, vasospasm, microvascular dysfunction, spontaneous coronary artery dissection, and coronary embolism—as well as from non-ischemic causes, such as myocarditis and Takotsubo cardiomyopathy. The diagnostic evaluation of MINOCA relies on high-sensitivity troponin assays, coronary angiography, cardiac magnetic resonance (CMR) imaging, optical coherence tomography, and functional testing for vasomotor disorders. There are emerging biomarkers, including microRNAs, copeptin, and soluble suppression of tumorigenicity-2, that help refine the risk assessment. We concluded that MINOCA requires a stepwise diagnostic algorithm and personalized treatment methods tailored to the underlying cause, while advocating for early use of CMR imaging, targeted imaging or functional tests, and long-term follow-up. Future randomized trials are warranted to validate etiology-specific therapies and imaging-guided management strategies.

Keywords

Myocardial infarction / Non-obstructive coronary artery disease / Biomarkers / Heart muscle injury / Coronary vasospasm

Acknowledgments

None.

Funding

None.

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Sai Lokesh Moraboina, Mehreen Junaid

Visualization: Kalpana Kumari, Yusra Jumani

Writing-original draft: Sai Lokesh Moraboina, Mehreen Junaid, Suman Khatri, Umme Aiman, Varsha Miriyala

Writing-review & editing: Kalpana Kumari, Ali Athar, Jeevan Kumar Sahni, Yusra Jumani

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Not applicable.

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