Abstract
When acute myocardial injury is found in a clinical setting suggestive of myocardial ischemia, the event is labeled as acute myocardial infarction (MI), and the absence of ≥50% coronary stenosis at angiography or greater leads to the working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA). Determining the mechanism of MINOCA and excluding other possible causes for cardiac troponin elevation has notable implications for tailoring secondary prevention measures aimed at improving the overall prognosis of acute MI. The aim of this review is to increase the awareness that establishing the underlying cause of a MINOCA is possible in the vast majority of cases, and that the proper classification of any MI should be pursued. The initial diagnosis of MINOCA can be confirmed or ruled out based on the results of subsequent investigations. Indeed, a comprehensive clinical evaluation at the time of presentation, followed by a dedicated diagnostic work-up, might lead to the identification of the pathophysiologic abnormality leading to MI in almost all cases initially labeled as MINOCA. When a specific cause of acute MI is identified, cardiologists are urged to transition from the “all-inclusive” term “MINOCA” to the proper classification of any MI, as evidence now exists that MINOCA does not provide conceptual clarity for actionable decision-making in MI with angiographically normal coronary arteries.
Highlights
According to the traditional view, myocardial ischemic conditions are closely linked to coronary atherosclerosis, with the progressive narrowing of the vessel lumen by plaque growth being the background of chronic myocardial ischemia (“stable angina”), and thrombus superimposition on a ruptured or fissured or eroded plaque being the precipitating mechanism of acute myocardial ischemia [1]
The results of this study demonstrated that baseline Myocardial blood flow (MBF) remained constant despite the increasing severity of the stenosis, even in patients with >80% luminal diameter reduction
This multicenter study identified the cause for the suspected myocardial infarction with nonobstructed coronary arteries (MINOCA) patients in 85% of patients (64% myocardial infarction (MI), 15% myocarditis, 3% Takotsubo syndrome (TTS), and 3% cardiomyopathy), which was better than either of the diagnostic technologies alone (i.e., 44% for optical coherence tomography (OCT) and 74% for cardiac magnetic resonance (CMR) imaging alone), and reflects the ability to correlate the findings of the two diagnostic technologies
Summary
According to the traditional view, myocardial ischemic conditions are closely linked to coronary atherosclerosis, with the progressive narrowing of the vessel lumen by plaque growth being the background of chronic myocardial ischemia (“stable angina”), and thrombus superimposition on a ruptured or fissured or eroded plaque being the precipitating mechanism of acute myocardial ischemia [1]. Scientific guidelines eventually acknowledged the multifactorial nature of “stable angina” and proposed a nomenclature shift for this condition in 2019, suggesting the term “chronic coronary syndromes” [4] The implications of this new terminology, expressing a major change in the understanding of chronic myocardial ischemia, are deep and wide. It will take time to achieve a full application in clinical practice, but the cultural process has been activated [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
