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 May 31;12(11):3799.
doi: 10.3390/jcm12113799.

MINOCA Associated with a Myocardial Bridge: Pathogenesis, Diagnosis and Treatment

Riccardo Rinaldi  1 , Giuseppe Princi  1 , Giulia La Vecchia  1 , Alice Bonanni  2 , Giovanni Alfonso Chiariello  2 , Alessandro Candreva  3 , Felice Gragnano  4 , Paolo Calabrò  4   5 , Filippo Crea  1   2 , Rocco A Montone  2
Affiliations
Review

MINOCA Associated with a Myocardial Bridge: Pathogenesis, Diagnosis and Treatment

Riccardo Rinaldi et al. J Clin Med. .

Abstract

Myocardial bridging (MB) is the most frequent congenital coronary anomaly characterized by a segment of an epicardial coronary artery that passes through the myocardium. MB is an important cause of myocardial ischemia and is also emerging as a possible cause of myocardial infarction with non-obstructed coronary arteries (MINOCA). There are multiple mechanisms underlying MINOCA in patients with MB (i.e., MB-mediated increased risk of epicardial or microvascular coronary spasm, atherosclerotic plaque disruption and spontaneous coronary artery dissection). The identification of the exact pathogenetic mechanism is crucial in order to establish a patient-tailored therapy. This review provides the most up-to-date evidence regarding the pathophysiology of MINOCA in patients with MB. Moreover, it focuses on the available diagnostic tools that could be implemented at the time of coronary angiography to achieve a pathophysiologic diagnosis. Finally, it focuses on the therapeutic implications associated with the different pathogenetic mechanisms of MINOCA in patients with MB.

Keywords: MINOCA; diagnosis; management; myocardial bridge; pathogenesis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Invasive diagnostic algorithm in patients with MINOCA associated with myocardial bridging. Abbreviations: CAD: coronary artery disease; DFFR: diastolic fractional flow reserve; iFR: instantaneous wave-free ratio; IVUS: intravascular ultrasound; MINOCA: myocardial infarction with non-obstructed coronary arteries; OCT: optical coherence tomography; SCAD: spontaneous coro-nary artery dissection.
See this image and copyright information in PMC

References

    1. Thygesen K., Alpert J.S., Jaffe A.S., Chaitman B.R., Bax J.J., Morrow D.A., White H.D., Corbett S., Chettibi M., Hayrapetyan H., et al. Fourth Universal Definition of Myocardial Infarction (2018) Circulation. 2018;138:e618–e651. doi: 10.1161/CIR.0000000000000617. - DOI - PubMed
    1. Agewall S., Beltrame J.F., Reynolds H.R., Niessner A., Rosano G., Caforio A.L.P., De Caterina R., Zimarino M., Roffi M., Kjeldsen K., et al. ESC Working Group Position Paper on Myocardial Infarction with Non-Obstructive Coronary Arteries. Eur. Heart J. 2017;38:143–153. doi: 10.1093/eurheartj/ehw149. - DOI - PubMed
    1. Pelliccia F., Pasceri V., Niccoli G., Tanzilli G., Speciale G., Gaudio C., Crea F., Camici P.G. Predictors of Mortality in Myocardial Infarction and Nonobstructed Coronary Arteries: A Systematic Review and Meta-Regression. Am. J. Med. 2020;133:73–83.e4. doi: 10.1016/j.amjmed.2019.05.048. - DOI - PubMed
    1. Eggers K.M., Hjort M., Baron T., Jernberg T., Nordenskjöld A.M., Tornvall P., Lindahl B. Morbidity and Cause-Specific Mortality in First-Time Myocardial Infarction with Nonobstructive Coronary Arteries. J. Intern. Med. 2019;285:419–428. doi: 10.1111/joim.12857. - DOI - PubMed
    1. Nordenskjöld A.M., Lagerqvist B., Baron T., Jernberg T., Hadziosmanovic N., Reynolds H.R., Tornvall P., Lindahl B. Reinfarction in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Coronary Findings and Prognosis. Am. J. Med. 2019;132:335–346. doi: 10.1016/j.amjmed.2018.10.007. - DOI - PubMed

LinkOut - more resources