Faculty of Medicine, University of Porto, Porto, Portugal.
Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College University, London, UK.
Rev Port Cardiol. 2023 Jul;42(7):655-666. doi: 10.1016/j.repc.2022.10.007. Epub 2023 Mar 10.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is responsible for 10% of myocardial infarctions. Previously, patients were thought to have good prognosis, but evidence-based management and treatment strategies were scarce. Today, researchers and physicians recognize MINOCA as a condition with non-trivial mortality and morbidity. Therapeutic strategies are highly dependent on the underlying disease mechanism in each patient. However, to reach a diagnosis of MINOCA, a multimodal approach is required and, even with an optimal work-up, the cause remains unknown in 8-25% of patients. Research has been growing and position papers from the European Society of Cardiology (ESC) and the American Heart Association/American College of Cardiology have been published, and MINOCA has been included in the more recent ESC guidelines on myocardial infarction. Nonetheless, some clinicians still assume that the absence of coronary obstruction excludes the possibility of acute myocardial infarction. Therefore, in the present paper, we aim to compile and present the available data on the etiology, diagnosis, treatment, and prognosis of MINOCA.
非阻塞性冠状动脉心肌梗死（MINOCA）占心肌梗死的 10%。以前，人们认为此类患者的预后良好，但缺乏基于证据的管理和治疗策略。如今，研究人员和医生认识到 MINOCA 是一种死亡率和发病率都不容小觑的疾病。在每个患者中，治疗策略高度依赖于潜在的疾病机制。然而，为了做出 MINOCA 的诊断，需要采用多模式方法，即使进行了最佳的检查，仍有 8%-25%的患者病因不明。研究一直在不断发展，欧洲心脏病学会（ESC）和美国心脏协会/美国心脏病学会已发表相关立场文件，MINOCA 也被纳入 ESC 最近发布的心肌梗死指南。尽管如此，一些临床医生仍然认为没有冠状动脉阻塞可排除急性心肌梗死的可能性。因此，在本文中，我们旨在汇总和呈现 MINOCA 的病因、诊断、治疗和预后的现有数据。
