Introduction on Myocardial Infarction With Non-obstructive Coronary Arteries – Diagnosis and Management
Early coronary angiography performed during acute MI (AMI) identifies an occluded vessel in most patients with ST elevation MI (STEMI)1 and less frequently in those with non-STEMI;2 however, ≥90 % of patients with AMI have evidence of obstructive coronary artery disease.3 For these patients with overt coronary artery disease (CAD), the benefits of reperfusion strategies and cardioprotective therapies are well established and appropriate considering the documented atherothrombotic process involved. However, in up to 10 % of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of CAD.3 These patients constitute an intriguing subgroup referred to as MI with non-obstructive coronary arteries (MINOCA),4 which present a diagnostic and therapeutic conundrum to clinicians as prospective studies evaluating these patients are limited. This review evaluates the contemporary diagnosis and management of MINOCA.