Myocardial infarction with non-obstructive coronary arteries: A review

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCAs) affects about 15% of patients diagnosed with myocardial infarction (MI). Patients with MINOCA often lack significant cardiac risk factors such as diabetes mellitus, cigarette smoking, and hypertension. Notable, MINOCA is common among female individuals, often occurring in younger women. This highlights the importance of considering MINOCA in women presenting with symptoms suggestive of MI, even in the absence of conventional risk factors. Precisely, MINOCA is not a distinct disease entity but rather a working diagnosis which necessitates further evaluation. MINOCA results from a heterogeneous group of conditions that ultimately result in ischemic injury to the myocardium and causes can be cardiac (e.g., coronary embolism) or non-cardiac (e.g., sepsis). Diagnosis involves coronary angiography to rule out obstructive coronary artery disease (CAD) and transesophageal echocardiography for the assessment of regional wall motion abnormalities. Cardiovascular magnetic resonance imaging can be performed to rule out acute myocarditis or takotsubo cardiomyopathy, which is non-ischemic cause of myocardial injury in MINOCA. Management of MINOCA is specific to the underlying cause and usually influenced by the degree of myocardial damage, and the prognosis is variable and depends largely on the underlying etiology. While some studies suggest that MINOCA patients may have a better short-term prognosis compared to those with MI and obstructive CAD, they still face a significant risk of long-term adverse cardiovascular events, including recurrent MI, heart failure, stroke, and death. Identifying the specific causes of MINOCA is crucial for accurate risk stratification and tailored management to improve patient outcomes.

Keywords

Ischemic heart disease / Myocardial infarction / Non-obstructive coronary artery disease

Acknowledgments

None.

Funding

None.

Conflict of interest

The authors declare no conflict of interest.

Author contributions

Conceptualization: Vicky Kumar

Visualization: Vicky Kumar, Haris Muhammad

Writing - original draft: Vicky Kumar, Haris Muhammad

Writing- review & editing: Ilsa Fatima, Joan Fallouh, Rola Ali, Amer Hammad, Haris Usman, Oghenetejir Gbegbaje

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Not applicable.

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