Systematic Review of Patients Presenting With Suspected Myocardial Infarction and Non-Obstructive Coronary Arteries (MINOCA) | Journal Scan

Study Questions:

What are the prevalence, risk factors for, and prognosis in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA)?

Methods:

A search of PubMed and Embase was performed to identify studies that included patients who had documented MI and had undergone qualitative coronary angiography. A total of 152 publications were identified as including enough clarity to identify patients with MINOCA; from this, 28 studies were used for a quantitative assessment related to clinical factors associated with MINOCA, and 46 studies were used for a qualitative assessment of pathological factors.

Results:

The prevalence of MINOCA was 6% (95% confidence interval [CI], 5-7%) with a median patient age of 55 years (95% CI, 51-59 years), and 40% women. Compared to those with MI associated with obstructive coronary artery disease (MI-CAD), the patients with MINOCA were more likely to be younger and female, but less likely to have hyperlipidemia. Other cardiovascular risk factors were similar between the two groups. All-cause mortality at 12 months was lower in MINOCA (4.7%; 95% CI, 2.6-6.9%) compared to MI-CAD (6.7%; 95% CI, 4.3-9.0%). Qualitative assessment of 46 publications evaluating the underlying pathophysiology responsible for MINOCA revealed the presence of a typical myocardial infarct on cardiac magnetic resonance imaging in only 24% of patients, with myocarditis occurring in 33% and no significant abnormality in 26%. Coronary artery spasm was inducible in 27% of MINOCA patients, and thrombophilia disorders were detected in 14%.

Conclusions:

The authors concluded that MINOCA should be considered as a “working diagnosis” with multiple potential causes that require evaluation so that directed therapies may improve its guarded prognosis.

Perspective:

This review suggests that MINOCA is comprised of several etiologies. Understanding the patient and management factors related to improved long-term survival for subgroups of MINOCA will assist in the improved care for patients with MINOCA.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Coronary Artery Disease, Myocardial Infarction, Cardiovascular Diseases, Coronary Angiography, Hyperlipidemias, Magnetic Resonance Imaging, Myocarditis, Prevalence, Prognosis, Thrombophilia, Risk Factors


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