AUTHOR=Yildiz Mehmet , Ashokprabhu Namrita , Shewale Aarushi , Pico Madison , Henry Timothy D. , Quesada Odayme 

TITLE=Myocardial infarction with non-obstructive coronary arteries (MINOCA)

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1032436

DOI=10.3389/fcvm.2022.1032436

ISSN=2297-055X

ABSTRACT=Myocardial infarction (MI) without significant obstructive coronary artery disease (CAD) has been observed for decades in patients presenting with MI without a culprit artery. However, the term myocardial infarction with non-obstructive coronary arteries (MINOCA) was first introduced in 2013, and it was not until 2017 that the European Society of Cardiology (ESC) position paper on MINOCA introduced diagnostic criteria for MINOCA based on the third universal definition of MI as follows: the presence of positive cardiac biomarker with clinical evidence of infarction, absence of stenosis (≥50%) in any epicardial coronary arteries on coronary angiography, and lack of any alternative diagnosis for the index presentation. The underlying pathophysiologic mechanisms in MINOCA include: coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), coronary embolism/thrombosis, Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy. In 2018, the universal definition of MI was updated to include only ischemic mechanisms associated with myocardial injury, thereby excluding non-ischemic mechanisms such as Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy. Therefore, the American Heart Association (AHA) scientific statement in 2019 excluded non-ischemic mechanisms from the MINOCA definition and labeled them MINOCA mimickers.