MINOCA: Diagnostic work-up, risk stratification and tailored therapies

C Noel Bairey Merz; Martha Gulati; Janet Wei

doi:10.1016/j.vph.2023.107243

MINOCA: Diagnostic work-up, risk stratification and tailored therapies

Vascul Pharmacol. 2023 Dec:153:107243. doi: 10.1016/j.vph.2023.107243. Epub 2023 Nov 14.

Authors

C Noel Bairey Merz¹, Martha Gulati², Janet Wei²

Affiliations

¹ Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: merz@cshs.org.
² Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 37972700
DOI: 10.1016/j.vph.2023.107243

Abstract

Myocardial infarction with no obstructive coronary artery disease (MINOCA) diagnostic work-up, risk stratification and tailored therapies are emerging as the recognition of this type of MI is increasingly recognized. Diagnostic workup using advanced imaging can include coronary angiography/intravascular ultrasound (IVUS)/optical coherent tomography (OCT), echo and cardiac magnetic resonance imaging (MRI). Risk stratification portends an intermediate risk compared to multivessel obstructive coronary artery disease (CAD). While event rates are high enough to warrant concern, they are relatively low enough to require trials with large sample sizes and hard outcomes. Tailored therapies include common sense therapeutic lifestyle change (TLC) and optimal medical therapy (OMT) due to the high prevalence of non-obstructive CAD, however therapeutic clinical trials are needed. Currently one large outcome trial in ischemia with no obstructive coronary artery disease (INOCA) is ongoing.

Keywords: Myocardial infarction; No obstructive coronary disease.

Publication types

Editorial

MeSH terms

Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / therapy
Coronary Vessels / pathology
Humans
MINOCA
Myocardial Infarction* / diagnosis
Risk Assessment
Risk Factors