Research Topic

MINOCA: Pathogenesis, Diagnosis, Clinical management and Evolution Towards Precision Medicine

About this Research Topic

Myocardial infarction with non-obstructive coronary disease (MINOCA) represents a heterogeneous clinical conundrum representing about 6% of all acute myocardial infarction (MI) cases. Initially believed to be a benign condition associated with a favourable prognosis, it is now becoming clear that MINOCA is associated with a significant risk of mortality, rehospitalization, disability and angina burden at follow-up, with high socioeconomic costs, similar to those patients presenting with MI and obstructive coronary artery disease (CAD). In order to improve clinical outcomes and reduce the healthcare-related costs, it is mandatory to understand the burden of the problem and identify the specific causes of MINOCA so that therapy can be tailored on the underlying mechanism.

This Research Topic aims to:

1. Understand the burden of the problem: MINOCA represents about 6% of all patients presenting with acute myocardial infarction (MI) who are referred for coronary angiography. Several studies have shown that MINOCA patients have 1-year mortality and rehospitalization rate similar to those patients with acute MI. Furthermore, approximately 25% of patients with MINOCA will experience angina in the subsequent 12 months, which is at least as high as reported in patients with acute MI with CAD. This significantly impacts on quality of life and healthcare related costs especially if it is considered that MINOCA patients are usually younger than patients with acute MI in the presence of obstructive CAD.

2. Identify the specific causes of MINOCA through a multimodal diagnostic work-up: there is a variety of causes underlying this clinical entity including coronary plaque rupture/erosion, epicardial or microvascular spasm, and coronary embolism/thrombosis involving microcirculation. Therefore, MINOCA should not be considered as a single entity but a heterogeneous working diagnosis that requires a comprehensive evaluation to elucidate potential underlying cause.

3. Tailor therapeutic approach on the underlying mechanism: precision medicine is particularly important in addressing MINOCA because of the multiple causes of this condition requiring a personalized approach. To date, there are no prospective clinical trials in this population and cannot be assumed that benefits observed in studies of patients suffering from MI with obstructive CAD may be successfully translate to this enigmatic, pathophysiologically heterogeneous disorder.

This Research Topic will consider reviews, perspectives and original research submissions on the following topics, and any other works related to the theme of the Research Topic:

• Prevalence, incidence, gender difference in MINOCA
• Diagnostic work-up in MINOCA
• Role of functional test in MINOCA
• Role of cardiac Imaging in MINOCA
• Role of coronary advanced imaging (IVUS/OCT) in MINOCA
• Tailored drug treatment in MINOCA patients: focus on antiplatelet/anticoagulant
• Tailored drug treatment in MINOCA patients: focus on anti-ischemic/anginal drugs
• Role of comorbidities in MINOCA
• MINOCA in the elderly


Keywords: MINOCA, personalized medicine, Myocardial infarction, non-obstructive coronary disease


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Myocardial infarction with non-obstructive coronary disease (MINOCA) represents a heterogeneous clinical conundrum representing about 6% of all acute myocardial infarction (MI) cases. Initially believed to be a benign condition associated with a favourable prognosis, it is now becoming clear that MINOCA is associated with a significant risk of mortality, rehospitalization, disability and angina burden at follow-up, with high socioeconomic costs, similar to those patients presenting with MI and obstructive coronary artery disease (CAD). In order to improve clinical outcomes and reduce the healthcare-related costs, it is mandatory to understand the burden of the problem and identify the specific causes of MINOCA so that therapy can be tailored on the underlying mechanism.

This Research Topic aims to:

1. Understand the burden of the problem: MINOCA represents about 6% of all patients presenting with acute myocardial infarction (MI) who are referred for coronary angiography. Several studies have shown that MINOCA patients have 1-year mortality and rehospitalization rate similar to those patients with acute MI. Furthermore, approximately 25% of patients with MINOCA will experience angina in the subsequent 12 months, which is at least as high as reported in patients with acute MI with CAD. This significantly impacts on quality of life and healthcare related costs especially if it is considered that MINOCA patients are usually younger than patients with acute MI in the presence of obstructive CAD.

2. Identify the specific causes of MINOCA through a multimodal diagnostic work-up: there is a variety of causes underlying this clinical entity including coronary plaque rupture/erosion, epicardial or microvascular spasm, and coronary embolism/thrombosis involving microcirculation. Therefore, MINOCA should not be considered as a single entity but a heterogeneous working diagnosis that requires a comprehensive evaluation to elucidate potential underlying cause.

3. Tailor therapeutic approach on the underlying mechanism: precision medicine is particularly important in addressing MINOCA because of the multiple causes of this condition requiring a personalized approach. To date, there are no prospective clinical trials in this population and cannot be assumed that benefits observed in studies of patients suffering from MI with obstructive CAD may be successfully translate to this enigmatic, pathophysiologically heterogeneous disorder.

This Research Topic will consider reviews, perspectives and original research submissions on the following topics, and any other works related to the theme of the Research Topic:

• Prevalence, incidence, gender difference in MINOCA
• Diagnostic work-up in MINOCA
• Role of functional test in MINOCA
• Role of cardiac Imaging in MINOCA
• Role of coronary advanced imaging (IVUS/OCT) in MINOCA
• Tailored drug treatment in MINOCA patients: focus on antiplatelet/anticoagulant
• Tailored drug treatment in MINOCA patients: focus on anti-ischemic/anginal drugs
• Role of comorbidities in MINOCA
• MINOCA in the elderly


Keywords: MINOCA, personalized medicine, Myocardial infarction, non-obstructive coronary disease


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

31 August 2020 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

31 August 2020 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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