Title:Advances in Mechanisms and Treatment Options of MINOCA Caused by Vasospasm or Microcirculation Dysfunction
Volume: 24
Issue: 4
Author(s): Jacek Bil*, Natalia Pietraszek, Tomasz Pawlowski and Robert J. Gil
Affiliation:
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw,Poland
Keywords:
Variant angina, coronary spasm, vasospasm, acetylcholine, myocardial infarction with non-obstructive coronary arteries, coronary
angiography.
Abstract: Myocardial Infarction (MI) with Non-obstructive Coronary Arteries (MINOCA) is a syndrome with
underlying many causes. MINOCA incidence is estimated to be between 5% and 25% of all MI. The outcome is
extremely variable depending on the MINOCA cause. Clinical history, laboratory tests, echocardiography and
coronary angiography are the first line diagnostic investigations. Nevertheless, further tests are frequently necessary
(e.g. optical coherence tomography, invasive provocative test with acetylcholine or cardiac magnetic resonance)
to establish the exact cause, and allowing the adequate risk stratification and management. This is crucial
since many patients, particularly those with angiographically normal coronary arteries, are often labelled as ‘noncardiac',
therefore missing the chance for appropriate treatment. And this group of patients characterizes substantially
worse outcome than previously it was believed. Here, we have reviewed the pathogenesis, diagnosis, prognosis,
and management of MINOCA caused by coronary vasospasm or coronary microcirculation dysfunction.
