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      MINOCA: Myocardial infarction no obstructive coronary artery disease ☆

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          Abstract

          Myocardial infarction without obstructive coronary artery disease (MINOCA) is defined as myocardial infarction with mild or no obstructive coronary artery disease (CAD) on angiogram. MINOCA has a number of heterogeneous causes, including coronary disruption, coronary vasospasm, coronary embolism, spontaneous coronary artery dissection (SCAD), and coronary microvascular dysfunction (CMD). Even though MINOCA might have a better prognosis than MI with obstructive CAD, it is not benign. A stepwise diagnostic approach is crucial to identifying the underlying cause of MINOCA or conditions mimicking it. A cause-specific treatment approach is the key to managing MINOCA.

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          Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.

          Sivabaskari Pasupathy, Tracy A. Air, Rachel Dreyer … (2015)
          Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a puzzling clinical entity with no previous evaluation of the literature. This systematic review aims to (1) quantify the prevalence, risk factors, and 12-month prognosis in patients with MINOCA, and (2) evaluate potential pathophysiological mechanisms underlying this disorder.
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            TIMI frame count: a quantitative method of assessing coronary artery flow.

            C Gibson, C Cannon, W Daley … (1996)
            Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature. In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7 +/- 3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2 +/- 2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4 +/- 3.0) and circumflex counts (22.2 +/- 4.1, P < .001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2 +/- 20.0 frames, which improved to 31.7 +/- 12.9 frames by 18 to 36 hours (P < .001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5 +/- 9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0 +/- 3.1, P < .001) but improved to that of normal arteries by 1 day after thrombolysis (21.7 +/- 7.1, P=NS). The CTFC is a simple, reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
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              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

              Jacqueline E Tamis-Holland, Hani Jneid, Harmony R Reynolds … (2019)
              Myocardial infarction in the absence of obstructive coronary artery disease is found in ≈5% to 6% of all patients with acute infarction who are referred for coronary angiography. There are a variety of causes that can result in this clinical condition. As such, it is important that patients are appropriately diagnosed and an evaluation to uncover the correct cause is performed so that, when possible, specific therapies to treat the underlying cause can be prescribed. This statement provides a formal and updated definition for the broadly labelled term MINOCA (incorporating the definition of acute myocardial infarction from the newly released "Fourth Universal Definition of Myocardial Infarction") and provides a clinically useful framework and algorithms for the diagnostic evaluation and management of patients with myocardial infarction in the absence of obstructive coronary artery disease.
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                Author and article information

                Contributors
                C. Michael Gibson
                Journal
                Journal ID (nlm-ta): Am Heart J Plus
                Journal ID (iso-abbrev): Am Heart J Plus
                Title: American Heart Hournal Plus: Cardiology Research and Practice
                Publisher: Elsevier
                ISSN (Electronic): 2666-6022
                Publication date PMC-release: 29 July 2023
                Publication date Collection: September 2023
                Publication date (Electronic): 29 July 2023
                Volume: 33
                Electronic Location Identifier: 100312
                Affiliations
                [a ]Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
                [b ]Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
                Author notes
                [* ]Correspondent author at: Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 930 Commonwealth Ave #3, Boston, MA 02215, USA. charlesmichaelgibson@ 123456gmail.com
                Article
                Publisher Item ID: S2666-6022(23)00064-2 Publisher ID: 100312
                DOI: 10.1016/j.ahjo.2023.100312
                PMC ID: 10945965
                PubMed ID: 38510552
                SO-VID: c6f10094-b75c-4ad8-b697-298f81f8bcf0
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 19 April 2023
                Date revision received : 24 July 2023
                Date accepted : 28 July 2023
                Categories
                Subject: Review Article

                Keywords: cardiac mri,ivus,oct,minoca,scad
                Data availability:
                Keywords: cardiac mri, ivus, oct, minoca, scad

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