Myocardial Infarction No Obstructive Coronary Artery disease (MINOCA)
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Etiology
- atherosclerosis
- nonatherosclerotic causes
- coronary embolism/thrombosis
- coronary microvascular dysfunction
- epicardial coronary vasospasm
- spontaneous coronary artery dissection
- supply-demand mismatch
Epidemiology
- 5-6% of myocardial infarction[1]
Diagnostic criteria
- myocardial infarction
- nonobstructive coronary arteries
- no lesions >= 50% in a major epicardial vessel
- no alternative cause for the presentation.
Radiology
- cardiac magnetic resonance imaging
- can confirm myocardial infarction
- can exclude myocarditis, Takotsubo syndrome, &cardiomyopathy
Management
- prognosis:
- MINOCA patients with better outcomes than their counterparts with CAD
- high risk for recurrent events (25% in year 1)
- 4 year mortality 13%; < 1/2 of deaths were cardiovascular
- another MI occurred in 7%, ischemic stroke in 4%, & hospitalization for heart failure in 6%
More general terms
References
- ↑ 1.0 1.1 Tamis-Holland JE, Jneid H, Reynolds HR et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: A scientific statement from the American Heart Association. Circulation 2019 Mar 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30913893 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000670