Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India.
Curr Probl Cardiol. 2024 Feb;49(2):102185. doi: 10.1016/j.cpcardiol.2023.102185. Epub 2023 Nov 2.
Cardiovascular diseases, particularly myocardial infarction (MI), are a significant cause of mortality globally. Traditional MIs are commonly linked to substantial coronary artery blockage. However, a distinct subset of patients experience MI with non-obstructive coronary arteries, known as MINOCA. Imaging techniques, such as invasive coronary angiograms, are employed to diagnose MI or assess predisposition to one. Coronary angiograms help visualize vessel blockages; however, these blockages are absent in MINOCA cases, posing a diagnostic challenge. Precision medicine aims to introduce new diagnostic tools to assist in early diagnosis and further management of MINOCA. As percutaneous coronary intervention (PCI) does not benefit MINOCA patients, medical management tailored to the specific pathophysiological mechanism of MINOCA is employed. For example, if MINOCA is attributed to plaque disruption with or without plaque thrombus formation, the fundamental treatments may include statins, agents that modulate the renin-angiotensin system (RAS), and antiplatelet therapies. On the other hand, if coronary artery spasm is identified as the primary cause, essential intervention involves the use of calcium channel blockers. This approach has been previously utilized in patients with vasospastic angina and could be utilized in MINOCA, although research specific to MINOCA is ongoing. Therefore, the handling of MINOCA underscores the necessity for a tailored therapeutic strategy that corresponds to the underlying physiological mechanism responsible for the patient's clinical symptoms. Ongoing research initiatives are directed at expanding the availability of these treatments, uncovering new biomarkers, creating advanced diagnostic instruments, and establishing a more individualized approach for managing MINOCA patients.
心血管疾病，特别是心肌梗死（MI），是全球范围内导致死亡的主要原因。传统的 MI 通常与冠状动脉的严重阻塞有关。然而，有一部分患者的 MI 与非阻塞性冠状动脉有关，称为 MINOCA。采用血管造影等成像技术来诊断 MI 或评估 MI 的易患性。冠状动脉造影有助于观察血管阻塞情况；然而，MINOCA 病例中不存在这些阻塞，这给诊断带来了挑战。精准医学旨在引入新的诊断工具，以协助 MINOCA 的早期诊断和进一步管理。由于经皮冠状动脉介入治疗（PCI）对 MINOCA 患者无益，因此采用针对 MINOCA 特定病理生理机制的医疗管理方法。例如，如果 MINOCA 归因于斑块破裂伴或不伴斑块血栓形成，则基本治疗可能包括他汀类药物、调节肾素-血管紧张素系统（RAS）的药物和抗血小板治疗。另一方面，如果确定冠状动脉痉挛是主要原因，则基本干预措施包括使用钙通道阻滞剂。这种方法以前在血管痉挛性心绞痛患者中使用过，也可以在 MINOCA 患者中使用，尽管针对 MINOCA 的研究仍在进行中。因此，MINOCA 的处理强调需要制定针对特定生理机制的治疗策略，以对应患者的临床症状。正在进行的研究旨在扩大这些治疗方法的应用，揭示新的生物标志物，开发先进的诊断仪器，并为 MINOCA 患者建立更个体化的管理方法。
