British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
Heart. 2021 Sep;107(18):1458-1464. doi: 10.1136/heartjnl-2020-318269. Epub 2021 Feb 10.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) was first described over 80 years ago. The term has been widely and inconsistently used in clinical practice, influencing various aspects of disease classification, investigation and management. MINOCA encompasses a heterogenous group of conditions that include both atherosclerotic and non-atherosclerotic disease resulting in myocardial damage that is not due to obstructive coronary artery disease. In many ways, it is a term that describes a moment in the diagnostic pathway of the patient and is arguably not a diagnosis. Central to the definition is also the distinction between myocardial infarction and injury. The universal definition of myocardial infarction distinguishes acute myocardial infarction, including those with MINOCA, from other causes of myocardial injury by the presence of clinical evidence of ischaemia. However, these ischaemic features are often non-specific causing diagnostic confusion, and can create difficulties for patient management and follow-up. The purpose of this review is to summarise our current understanding of MINOCA and highlight important issues relating to the diagnosis, investigation and management of patients with MINOCA.
非阻塞性冠状动脉心肌梗死（MINOCA）早在 80 多年前就被首次描述。该术语在临床实践中被广泛且不一致地使用，影响疾病分类、调查和管理的各个方面。MINOCA 涵盖了一组异质的病症，包括导致心肌损伤但并非由于阻塞性冠状动脉疾病的动脉粥样硬化和非动脉粥样硬化性疾病。在许多方面，它是描述患者诊断路径中的一个时刻的术语，可以说不是一种诊断。定义的核心还在于心肌梗死和损伤之间的区别。心肌梗死的通用定义通过存在缺血的临床证据，将急性心肌梗死（包括 MINOCA 患者）与其他心肌损伤原因区分开来。然而，这些缺血特征通常是非特异性的，导致诊断混淆，并给患者管理和随访带来困难。本文旨在总结我们目前对 MINOCA 的理解，并强调与 MINOCA 患者的诊断、调查和管理相关的重要问题。
