AcuteMyocardial Infarctionwith Non - Obstructive Coronary Arteries - MINOCA: an enigma for the clinical cardiologist

Abstract

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a recently defined condition in cardiology practice. The diagnosis starts with coronary angiography that is the beginning of an etiological research process, often complex, but with prognostic and therapeutic importance for each etiology. There are different mechanisms involved in MINOCA, which are posed once pulmonary embolism, myocarditis and takotsubo cardiomyopathy are excluded.
It is described an epicardial pattern of MINOCA in cases of plaque disruption, dissection, vasospasm, and eventually coronary embolism; and a microvascular pattern in cases of microvascular spasm and small vessel coronary embolism. Several tools are useful in its study, such as echocardiography, left ventriculography, intravascular imaging techniques, study of coronary flow, and cardiac magnetic resonance, among others. Its use should be guided by clinical criteria. Despite there is no clearly established algorithm in our current practice, it is necessary to incorporate all available tools to approach the definitive MINOCA etiology whenever is possible. The aim of this review is to bring useful information to the clinical cardiologist for his daily practice.