Mangiacapra Fabio, Viscusi Michele Mattia, Paolucci Luca, Nusca Annunziata, Melfi Rosetta, Ussia Gian Paolo, Grigioni Francesco
Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
Front Cardiovasc Med. 2021 Nov 17;8:781485. doi: 10.3389/fcvm.2021.781485. eCollection 2021.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) encompasses several pathophysiological mechanisms not yet fully understood. Among the latter, vasomotion abnormalities and coronary microvascular dysfunction (CMD) play a major role for both epidemiological and prognostic reasons. Despite current guidelines do not recommend routine physiological assessment of both epicardial and microvascular coronary compartments within the context of an acute myocardial infarction, several recent evidence support the critical role of a comprehensive invasive functional assessment in order to identify the underlying pathophysiological mechanism and consequently to select an appropriate therapeutic strategy. Unfortunately, optimal medical therapy for these patients is not currently established due to the lack of dedicated trials evaluating clinical outcomes of commonly used medications for secondary prevention in MINOCA patients. For this reason, additional research is warranted to provide personalized treatments for patients affected by this puzzling clinical entity.
非阻塞性冠状动脉心肌梗死（MINOCA）包含几种尚未完全了解的病理生理机制。其中，血管运动异常和冠状动脉微血管功能障碍（CMD）在流行病学和预后方面都起着重要作用。尽管目前的指南不建议在急性心肌梗死的情况下对心外膜和微血管冠状动脉腔进行常规生理评估，但最近的一些证据支持全面侵入性功能评估的关键作用，以便确定潜在的病理生理机制，从而选择合适的治疗策略。不幸的是，由于缺乏评估MINOCA患者二级预防常用药物临床结局的专门试验，目前尚未确定这些患者的最佳药物治疗方案。因此，有必要进行更多研究，为受这种令人困惑的临床实体影响的患者提供个性化治疗。
