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Review
. 2025 Feb 10;12(2):64.
doi: 10.3390/jcdd12020064.

ANOCA, INOCA, MINOCA: The New Frontier of Coronary Syndromes

Antonio L M Parlati  1 , Ermanno Nardi  1 , Vincenzo Sucato  2 , Cristina Madaudo  2 , Giulio Leo  3 , Tanisha Rajah  4 , Federica Marzano  1 , Maria Prastaro  1 , Paola Gargiulo  1 , Stefania Paolillo  1 , Giuseppe Vadalà  2 , Alfredo Ruggero Galassi  2 , Pasquale Perrone Filardi  1
Affiliations
Review

ANOCA, INOCA, MINOCA: The New Frontier of Coronary Syndromes

Antonio L M Parlati et al. J Cardiovasc Dev Dis. .

Abstract

The growing prevalence in the diagnosis of INOCA (Ischemia with Non-Obstructive Coronary Arteries), ANOCA (Angina with Non-Obstructive Coronary Arteries), and MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) highlights the need to reassess their clinical relevance. Historically regarded as benign syndromes, emerging evidence suggests that these conditions may cause serious cardiovascular events and considerable long-term disability. Additionally, emerging studies suggest that non-obstructive coronary artery disease (CAD) may have a higher prevalence compared to traditional obstructive forms of CAD. This leads to the need to better clarify the underlying pathogenic mechanisms as well as the risk factors associated with these syndromes. This is precisely the aim of this review, which focuses on the complex and heterogeneous mechanisms underlying these syndromes as well as the associated risk factors. This review also sums up the diagnostic steps necessary to achieve an accurate diagnosis, along with the interventional and pharmacological approaches to be implemented in light of the latest evidence.

Keywords: ANOCA; IHD; INOCA; MINOCA.

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Conflict of interest statement

The authors certify that there are no conflicts of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 3
Figure 3
Pathogenetic mechanism of MINOCA. MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries.
Figure 1
Figure 1
Management of ANOCA/INOCA. ACEi: angiotensin-converting enzyme inhibitors; ANOCA: Angina with Non-Obstructive Coronary Arteries; ARBs: angiotensin II receptor blockers; CAD: coronary artery disease; CCB: calcium channel blocker; CCTA: coronary computed tomography angiography; CMD: microvascular dysfunction; CFR: coronary flow reserve; GMDT: guideline-directed medical therapy; CV: cardiovascular; ECG: electrocardiogram; HMR: hyperemic microvascular resistance index; ICA: invasive coronary angiography; IMR: index of microvascular resistance; INOCA: ischemia with non-obstructive coronary arteries; MRI: cardiac magnetic resonance; PET: positron emission tomography; SPECT: single photon emission tomography.
Figure 2
Figure 2
Diagnostic criteria of MINOCA. MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries.
Figure 4
Figure 4
Diagnostic algorithm of MINOCA. CMR: cardiac magnetic resonance; IVUS: intravascular ultrasound; MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries; OCT: optical coherence tomography.
See this image and copyright information in PMC

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