Department of Medicine, Hôpital Pierre-Boucher, Centre de santé et de services sociaux de la Montérégie-Est, Longueuil, Québec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Can J Cardiol. 2024 Jun;40(6):953-968. doi: 10.1016/j.cjca.2024.02.032.
Myocardial infarction with no obstructive coronary artery disease (MINOCA) represents 6%-15% of all acute coronary syndromes, and women are disproportionately represented. MINOCA is an encompassing preliminary diagnosis, and emerging evidence supports a more expansive comprehensive diagnostic and therapeutic clinical approach. The current clinical practice update summarizes the latest evidence regarding the epidemiology, clinical presentation, and diagnostic evaluation of MINOCA. A cascaded approach to diagnostic workup is outlined for clinicians, for noninvasive and invasive diagnostic pathways, depending on clinical setting and local availability of diagnostic modalities. Evidence concerning the nonpharmacological and pharmacological treatment of MINOCA are presented and summarized according to underlying cause of MINOCA, with practical tips on the basis of expert opinion, outlining a real-life, evidence-based, comprehensive approach to management of this challenging condition.
无阻塞性冠状动脉疾病的心肌梗死（MINOCA）占所有急性冠状动脉综合征的 6%-15%，女性的比例不成比例。MINOCA 是一个全面的初步诊断，新出现的证据支持更广泛的综合诊断和治疗临床方法。本临床实践更新总结了 MINOCA 的最新流行病学、临床表现和诊断评估证据。为临床医生概述了诊断工作的级联方法，包括非侵入性和侵入性诊断途径，具体取决于临床环境和当地诊断方式的可用性。根据 MINOCA 的潜在病因，介绍和总结了 MINOCA 的非药物和药物治疗证据，并根据专家意见提供了实用提示，概述了管理这种具有挑战性的疾病的现实生活、基于证据的综合方法。
