Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi," Ancona, Italy.
Department of Neuroscience, Imaging and clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
Curr Probl Cardiol. 2021 Mar;46(3):100761. doi: 10.1016/j.cpcardiol.2020.100761. Epub 2020 Dec 10.
Myocardial infarction without obstructive coronary artery disease (MINOCA) is defined by the evidence of spontaneous acute myocardial infarction (MI) and angiographic exclusion of coronary stenoses ≥50% in any potential infarct related artery, after having ruled out other clinically overt causes for the acute presentation. The introduction of this new concept was meant to encourage discovery of putative pathophysiological mechanisms and development of specific therapeutic measures. In recent years, we have witnessed significant advances in the fields of epidemiology, pathophysiology, diagnosis, prognosis estimation and therapeutics of MINOCA. So far, however, the definition of MINOCA has been rather heterogeneous since specific cardiac conditions such as myocarditis and Takotsubo syndrome have often been included, generating conflicting results. In this review, we summarize the current state-of-the-art in the expanding MINOCA field and propose a comprehensive stepwise approach for the rational diagnostic assessment of these challenging patients. Our aim is to provide clinicians with an "Ariadne's thread" according to the recent fourth universal definition of MI in order to not get lost in MINOCA's labyrinth.
无阻塞性冠状动脉疾病的心肌梗死（MINOCA）的定义为：在排除其他明显的急性表现的临床病因后，通过自发急性心肌梗死（MI）的证据和任何潜在梗死相关动脉中≥50%的冠状动脉狭窄的血管造影排除，定义为无阻塞性冠状动脉疾病的心肌梗死（MINOCA）。引入这一新概念旨在鼓励发现潜在的病理生理机制，并开发特定的治疗措施。近年来，MINOCA 的流行病学、病理生理学、诊断、预后评估和治疗领域取得了重大进展。然而，迄今为止，MINOCA 的定义一直相当混杂，因为常包括心肌炎和 Takotsubo 综合征等特定的心脏疾病，从而产生了相互矛盾的结果。在这篇综述中，我们总结了不断发展的 MINOCA 领域的最新现状，并提出了一种综合的逐步方法，用于对这些具有挑战性的患者进行合理的诊断评估。我们的目的是根据最近的第四次 MI 通用定义为临床医生提供一条“阿里阿德涅线”，以免在 MINOCA 的迷宫中迷失方向。
