Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun;25(6):561-570.
doi: 10.1007/s11886-023-01874-x. Epub 2023 Apr 17.

Contemporary Diagnosis and Management of Patients with MINOCA

Purvi Parwani  1   2 , Nicolas Kang  3   4 , Mary Safaeipour  3   4 , Mamas A Mamas  5 , Janet Wei  6 , Martha Gulati  6 , Srihari S Naidu  7 , Noel Bairey Merz  6
Affiliations
Review

Contemporary Diagnosis and Management of Patients with MINOCA

Purvi Parwani et al. Curr Cardiol Rep. 2023 Jun.

Abstract

Purpose of review: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%. MINOCA is diagnostically challenging and complex, making it difficult to manage effectively. This condition accounts for 6-8% of all MI and poses an increased risk of morbidity and mortality after diagnosis. Prompt recognition and targeted management are essential to improve outcomes and our understanding of this condition, but this process is not yet standardized. This article offers a comprehensive review of MINOCA, delving deep into its unique clinical profile, invasive and noninvasive diagnostic strategies for evaluating MINOCA in light of the lack of widespread availability for comprehensive testing, and current evidence surrounding targeted therapies for patients with MINOCA.

Recent findings: MINOCA is not uncommon and requires comprehensive assessment using various imaging modalities to evaluate it further. MINOCA is a heterogenous working diagnosis that requires thoughtful approach to diagnose the underlying disease responsible for MINOCA further.

Keywords: CMD; INOCA; MINOCA; Microvascular disease; PET; Stress CMR; VSA.

PubMed Disclaimer

Conflict of interest statement

NBM receives consulting fees from iRhythm and SHL Telemedicine. MG served on an advisory board for Novartis and was a speaker for Siemens Healthcare Diagnostics. She is a co-investigator and site PI of the Women’s Ischemia Trial to Reduce Events In Non-Obstructive CAD (WARRIOR) Study funded by the Department of Defense (Award Number: W81XWH-17–2-0030) and a co-investigator of the Women Ischemic Syndrome Evaluation (WISE) Study funded by the NHLBI. She is also the president of the American Society for Preventive Cardiology (unpaid). JW served on an advisory board for Abbott Vascular (paid to institution). PP received payment or honoraria from AstraZeneca and participated on a Data Safety Monitoring Board or Advisory Board for Medtronic.

Figures

Fig. 1
Fig. 1
Myocardial injury classification. Abbreviations: MINOCA, myocardial infarction with nonobstructive coronary arteries; MI, myocardial infarction; MI-CAD, myocardial infarction due to obstructive coronary artery disease; SCAD, spontaneous coronary artery dissection. Proportions of ischemic and nonischemic myocardial injury based on Pasupathy et al. [9], significant variability with exact proportions of ischemic etiology of MINOCA and the figure merely has graphical representation of ischemic etiology of MINOCA
Fig. 2
Fig. 2
Diagnostic algorithm for evaluating patients with suspected MINOCA. Abbreviations: CMR, cardiac magnetic resonance; cTn, cardiac troponin; LV, left ventricular; MINOCA, myocardial infarction with nonobstructive coronary arteries; TEE, transesophageal echocardiogram; VF, ventricular fibrillation; VT, ventricular tachycardia
See this image and copyright information in PMC

References

    1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018) Circulation. 2018;138(20):e618–e651. doi: 10.1161/CIR.0000000000000617/FORMAT/EPUB. - DOI - PubMed
    1. Davies MJ. The pathophysiology of acute coronary syndromes. Heart. 2000;83(3):361–366. doi: 10.1136/heart.83.3.361. - DOI - PMC - PubMed
    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;139(18):E891-E908. 10.1161/CIR.0000000000000670/FORMAT/EPUB. This study is important because it was the first scientific statement from AHA that described the diagnostic approach to patients presenting with MINOCA. - PubMed
    1. • Pasupathy S, Lindahl B, Litwin P, et al. Survival in patients with suspected myocardial infarction with nonobstructive coronary arteries: a comprehensive systematic review and meta-analysis from the MINOCA global collaboration. Circ Cardiovasc Qual Outcomes. 2021;14(11):e007880. 10.1161/CIRCOUTCOMES.121.007880/FORMAT/EPUB. This study is important because it shows that MINOCA, a condition previously dismissed as benign, has increased risk of adverse outcomes compared to healthy subjects but had a favorable prognosis compared to MI-CAD. - PubMed
    1. Agewall S, Beltrame JF, Reynolds HR, et al. Current opinion ESC working group position paper on myocardial infarction with non-obstructive coronary arteries on behalf of the WG on Cardiovascular Pharmacotherapy. 10.1093/eurheartj/ehw149. - PubMed

Publication types