Myocardial infarction with non obstructive coronary arteries (MINOCA): a whole new ball game

ABSTRACT

Introduction: MINOCA is a clinical syndrome that encompasses a subgroup of heterogeneous patients who present with myocardial infarction yet do not have any significant coronary artery obstruction on angiogram. As many as one in ten patients with acute myocardial infarction (AMI) will not have an occluded coronary artery, and the reported prevalence keeps rising, in part due to better recognition of this syndrome. Current guidelines offer several diagnostic algorithms but MINOCA remains largely under-recognised and little is known about whether patients might benefit from a more specific treatment modality.

Areas covered: We review pathogenesis, diagnosis, prognosis, and management of MINOCA.

Expert commentary: Due to the significant heterogeneity of MINOCA patients, a more efficient management strategy may solely rely on an individualized approach in order to improve outcomes.

KEYWORDS:

• MINOCA
• myocardial infarction
• non-obstructive coronary arteries
• coronary artery spasm
• plaque disruption
• embolisation

Acknowledgments

The authors would like to thank Angela Frei (Case Manager for the Cardiovascular Center, University Hospital of Geneva) for proofreading and A-L Hachulla (MD) for helping out with MRI image selections.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.