A Review of the Evidence for Treatment of Myocardial Infarction With Nonobstructive Coronary Arteries

• Published in: CJC open (Online) 2020-09, Vol.2 (5), p.395-401
• Main Authors: Sluchinski, Shelby L., Pituskin, Edith, Bainey, Kevin R., Norris, Colleen M.
• Format: Article
• Language: English
• Subjects: Review
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2020.03.016

Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is reported in 6% of patients with acute MI referred for catheterization. Because of the complex etiology and a limited amount of evidence, the treatment of MINOCA remains elusive. The etiology of MINOCA manifests from several causes including plaque disruption or erosion, epicardial coronary artery vasospasm, and coronary microvascular dysfunction. In addition, spontaneous coronary artery dissection, takotsubo, and myocarditis have been identified as contributing to the diagnosis of MINOCA. Patients with MINOCA are frequently young, non-white females with fewer traditional risk factors compared with those with an MI caused by obstructive coronary disease. Moreover, women who suffered an MI are 5 times more likely to be diagnosed with MINOCA with a trend for worse outcomes compared with men. The increased recognition/diagnosis of MINOCA has highlighted a gap in our understanding of the treatment of MINOCA. This review identified that there is a paucity of evidence on treatment strategies for patients clinically diagnosed with MINOCA, but more importantly that MINOCA should be viewed as a “syndrome” with many different pathologic causes. This suggests that a standard protocol may not be useful for patients with MINOCA. Given the ongoing debate over the complexity of MINOCA, the main focus in the management of MINOCA should be to identify the underlying mechanism for targeted therapies that may optimize outcomes. Un infarctus du myocarde (IM) à coronaires saines est signalé chez 6 % des patients ayant subi un IM aigu orientés en cardiologie pour subir un cathétérisme. En raison de la complexité du tableau étiologique et de la rareté des données probantes, le traitement de l’IM à coronaires saines demeure insaisissable. L’IM à coronaires saines est attribuable à plusieurs causes, dont la rupture ou l’érosion de plaque, le vasospasme coronarien épicardique et la dysfonction microvasculaire coronarienne. De plus, la dissection spontanée de l’artère coronaire, le syndrome de takotsubo et la myocardite contribuent notoirement au diagnostic de l’IM à coronaires saines. L’IM à coronaires saines survient souvent chez de jeunes femmes non blanches présentant moins de facteurs de risque classiques que les sujets victimes d’un IM causé par une coronaropathie obstructive. Par ailleurs, la probabilité d’un diagnostic d’IM à coronaires saines est cinq fois plus élevée chez les femmes ayant subi un