What an Interventionalist Needs to Know About MI with Non-obstructive Coronary Arteries

Robert Sykes, Daniel Doherty, Kenneth Mangion, Andrew Morrow, Colin Berry, Robert Sykes, Daniel Doherty, Kenneth Mangion, Andrew Morrow, Colin Berry

Abstract

MI with non-obstructive coronary arteries (MINOCA) is caused by a heterogeneous group of vascular or myocardial disorders. MINOCA occurs in 5.15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. The diagnosis of MINOCA is made during coronary angiography following acute MI, where there is no stenosis ≥50% present in an infarct-related epicardial artery and no overt systemic aetiology for the presentation. Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging, coronary function testing and subsequent imaging to assess for myocardial disorders without coronary involvement. Although plaque-related MINOCA is currently managed with empirical secondary prevention strategies, there remains an unmet therapeutic need for targeted and evidence-based therapy for MINOCA patients and increased awareness of the recommended diagnostic pathway.

Keywords: MI; MINOCA; acute coronary syndrome; interventional cardiology; non-obstructive coronary artery disease.

Conflict of interest statement

Disclosure: CB is employed by the University of Glasgow, which holds consultancy and research agreements for his work with companies that have commercial interests in the diagnosis and treatment of angina, including Abbott Vascular, AstraZeneca, Boehringer Ingelheim, GSK, HeartFlow, Menarini, Novartis and Siemens Healthcare. CB is supported by research funding from the British Heart Foundation (PG/17/2532884, RE/13/5/30177, RE/18/6/34217). All other authors have no conflicts of interest to declare.

Copyright © 2021, Radcliffe Cardiology.

Figures

Figure 1:. Angiography of MINOCA
Figure 1:. Angiography of MINOCA
Figure 2:. Diagnostic Pathway for MINOCA
Figure 2:. Diagnostic Pathway for MINOCA
Figure 3:. MINOCA and Cardiac MRI
Figure 3:. MINOCA and Cardiac MRI

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Source: PubMed

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