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Myocardial Infarction No Obstructive Coronary Artery disease (MINOCA)
Diagnostic criteria:
- myocardial infarction
- nonobstructive coronary arteries
- no lesions >= 50% in a major epicardial vessel
- no alternative cause for the presentation.
Etiology:
- atherosclerosis
- plaque disruption: plaque rupture or erosion or calcific nodules
- 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]
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%
General
myocardial infarction (MI); heart attack
References
- 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: 30913893
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000670