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Int J Angiol
DOI: 10.1055/s-0041-1724040
Review Article

Myocardial Infarction with Nonobstructive Coronary Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

Patrick Baghdasaryan
1   Division of Cardiology, University of California Riverside School of Medicine, CA
,
Balaji Natarajan
1   Division of Cardiology, University of California Riverside School of Medicine, CA
,
Madlena Nalbandian
2   Internal Medicine, St. Mary Medical Center, Long Beach, CA
,
Padmini Varadarajan
1   Division of Cardiology, University of California Riverside School of Medicine, CA
,
Ramdas G. Pai 
1   Division of Cardiology, University of California Riverside School of Medicine, CA
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Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a complex clinical syndrome that is characterized by evidence of acute myocardial infarction in the absence of significant epicardial coronary artery disease on angiography. The term “MINOCA” encompasses a group of heterogeneous diseases with varying underlying mechanisms and each with its own pathophysiology. Overlooked plaque rupture or erosion and coronary vasospasm are the most common causes of MINOCA and can be diagnosed by routine intracoronary imaging and vasoreactivity testing, respectively. Coronary microvascular dysfunction is a less recognized, albeit an important cause of morbidity in patients presenting with MINOCA. Although MINOCA is a rare presentation of acute coronary syndrome, it is not a benign disorder and can have adverse consequences if untreated. In this article, we aim to review the pathogenesis, clinical characteristics, and finally propose a systematic approach in the diagnosis and management of patients with MINOCA.

Keywords

MINOCA - acute myocardial infarction - plaque rupture - coronary vasospasm - microvascular dysfunction - spontaneous coronary artery dissection - coronary embolism

Authors' Contribution

Dr. Baghdasaryan and Dr. Natarajan contributed equally to the manuscript.


Disclosures

None of the authors have any disclosures relevant to the content of this manuscript.




Publication History

Received: 05 January 2021

Accepted: 25 January 2021

Article published online:
03 March 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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