Boivin-Proulx Laurie-Anne, Haddad Kevin, Lombardi Marco, Chong Aun Yeong, Escaned Javier, Mukherjee Swati, Forcillo Jessica, Potter Brian J, Coutinho Thais, Pacheco Christine
Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
CJC Open. 2023 Nov 18;6(2Part B):380-390. doi: 10.1016/j.cjco.2023.11.014. eCollection 2024 Feb.
Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is defined as acute myocardial infarction (AMI) with angiographically nonobstructive coronary artery disease. MINOCA represents 6% of all AMI cases and is associated with increased mortality and morbidity. However, the wide array of pathophysiological factors and causes associated with MINOCA presents a diagnostic conundrum. Therefore, we conducted a contemporary systematic review of the pathophysiology of MINOCA.
A comprehensive systematic review of MINOCA was carried out through the utilization of the PubMed database. All systematic reviews, meta-analyses, randomized controlled trials, and cohort studies available in English or French that reported on the pathophysiology of MINOCA published after January 1, 2013 were retained.
Of the 600 identified records, 80 records were retained. Central to the concept of MINOCA is the definition of AMI, characterized by the presence of myocardial damage reflected by elevated cardiac biomarkers in the setting of acute myocardial ischemia. As a result, a structured approach should be adopted to thoroughly assess and address clinically overlooked obstructive coronary artery disease, and cardiac and extracardiac mechanisms of myocyte injury. Once these options have been ruled out, a diagnosis of MINOCA can be established, and the appropriate multimodal assessment can be conducted to determine its specific underlying cause (plaque disruption, epicardial coronary vasospasm, coronary microvascular dysfunction, and coronary embolism and/or spontaneous coronary dissection or supply-demand mismatch).
Integrating a suitable definition of AMI and understanding the pathophysiological mechanisms of MINOCA are crucial to ensure an effective multimodal diagnostic evaluation and the provision of adequate tailored therapies.
非阻塞性冠状动脉疾病所致心肌梗死（MINOCA）被定义为冠状动脉造影无阻塞性病变的急性心肌梗死（AMI）。MINOCA占所有AMI病例的6%，且与死亡率和发病率增加相关。然而，与MINOCA相关的众多病理生理因素和病因带来了诊断难题。因此，我们对MINOCA的病理生理学进行了一项当代系统性综述。
通过使用PubMed数据库对MINOCA进行了全面的系统性综述。保留了2013年1月1日之后发表的所有以英文或法文报道MINOCA病理生理学的系统性综述、荟萃分析、随机对照试验和队列研究。
在600条识别记录中，保留了80条记录。MINOCA概念的核心是AMI的定义，其特征是在急性心肌缺血情况下，心脏生物标志物升高反映出心肌损伤的存在。因此，应采用结构化方法来全面评估和处理临床上被忽视的阻塞性冠状动脉疾病以及心肌细胞损伤的心脏和心外机制。一旦排除这些情况，即可确立MINOCA的诊断，并进行适当的多模式评估以确定其具体潜在病因（斑块破裂、心外膜冠状动脉痉挛、冠状动脉微血管功能障碍、冠状动脉栓塞和/或自发性冠状动脉夹层或供需不匹配）。
整合合适的AMI定义并理解MINOCA的病理生理机制对于确保有效的多模式诊断评估和提供适当的个体化治疗至关重要。
