Rodríguez Candelario Isabel I, Perez-Aybar Adrian E, Roman-Ramos Jose A
Cardiovascular Disease, Centro Médico Episcopal San Lucas, Ponce, PRI.
Internal Medicine, VA Caribbean Healthcare System, San Juan, PRI.
Cureus. 2023 Nov 30;15(11):e49695. doi: 10.7759/cureus.49695. eCollection 2023 Nov.
Cases of patients presenting with myocardial infarction (MI) without angiographic obstructive CAD are not trivial and have significant prevalence. "The Fourth Universal Definition of MI" (4UDMI) published in 2018 introduced MI with non-obstructive coronary arteries (MINOCA). The new section was of great importance as it validated the diagnosis by defining its criteria and recognizing its presence in the community and the need for further investigation. Given the nature of the diagnosis of MINOCA, coronary angiography provides limited information about prognosis and risk stratification for future major adverse cardiovascular events (MACE). Thus, additional imaging to understand the underlying etiology of MINOCA in conjunction with a better understanding of prognostic factors is necessary to expand on the current guidelines and aid in screening for possible complications, risk of MACE, and all-cause mortality. Discerning the etiology of the presentation is crucial, and physiologic studies, as well as additional imaging, are an important part of this evaluation. These modalities include intravascular studies such as optical coherence tomography (OCT), intravascular ultrasound (IVUS), fractional flow reserve (FFR), and imaging in the form of cardiac CT (CCT) and cardiac MRI (CMR). This step is essential to target treatment regimens more efficiently. The purpose of promoting multiple imaging modalities beyond traditional angiography is to address the working MINOCA diagnosis, with the finality of identifying the specific ischemic pathophysiology. MINOCA has multiple causative mechanisms, making it a heterogeneous collection of etiologies, resulting in acute MI: atherosclerotic, and non-atherosclerotic. This literature revision demonstrates that MINOCA prevalence and mortality are not trivial, and the diagnosis affects quality of life. MINOCA presents a definitive risk of MACE without proper stratification and targeted medical therapy. Several prognostic factors of morbidity and mortality in MI-CAD patients have been identified to correlate with MINOCA patients, especially inflammatory markers. MINOCA is not an exclusion diagnosis but a working diagnosis for which further imaging studies should be performed.
表现为心肌梗死（MI）但血管造影显示无阻塞性冠状动脉疾病（CAD）的患者病例并非少见，且患病率颇高。2018年发布的《心肌梗死的第四次全球定义》（4UDMI）引入了非阻塞性冠状动脉心肌梗死（MINOCA）。这一新章节至关重要，因为它通过定义标准、确认其在社区中的存在以及进一步调查的必要性，验证了该诊断。鉴于MINOCA诊断的性质，冠状动脉造影对于未来主要不良心血管事件（MACE）的预后和风险分层提供的信息有限。因此，需要额外的影像学检查来了解MINOCA的潜在病因，并更好地理解预后因素，以扩展当前指南并有助于筛查可能的并发症、MACE风险和全因死亡率。辨别发病原因至关重要，生理研究以及额外的影像学检查是该评估的重要组成部分。这些检查方式包括血管内研究，如光学相干断层扫描（OCT）、血管内超声（IVUS）、血流储备分数（FFR），以及心脏CT（CCT）和心脏MRI（CMR）形式的成像。这一步骤对于更有效地制定治疗方案至关重要。推广传统血管造影以外的多种成像方式的目的是解决现有的MINOCA诊断问题，最终确定特定的缺血病理生理学。MINOCA有多种致病机制，使其成为病因各异的集合，导致急性心肌梗死，包括动脉粥样硬化性和非动脉粥样硬化性。这篇文献综述表明，MINOCA的患病率和死亡率不容小觑，且该诊断会影响生活质量。MINOCA在没有适当分层和针对性药物治疗的情况下存在明确的MACE风险。已确定心肌梗死合并CAD患者的几个发病和死亡预后因素与MINOCA患者相关，尤其是炎症标志物。MINOCA不是排除性诊断，而是一个需要进行进一步影像学研究的现行诊断。
