Fatade Yetunde A, Newman Noah A, Patel Nidhi H, Mehta Puja K
J Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine Atlanta, GA, US.
Division of Cardiology, Emory University School of Medicine Atlanta, GA.
US Cardiol. 2024 Jul 23;18:e10. doi: 10.15420/usc.2023.12. eCollection 2024.
MI and non-obstructive coronary arteries (MINOCA) is recognized as an important contributor to adverse cardiovascular outcomes in both men and women but is particularly prevalent in young women. Multiple coronary mechanisms such as coronary plaque disruption, coronary artery spasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary thromboembolism can trigger MINOCA. Beyond routine left heart catheterization, invasive intracoronary imaging and cardiac MRI can help to clarify the cause of MINOCA. Conditions such as myocarditis, takotsubo syndrome, and cardiomyopathy are on the differential as alternate explanations in those suspected of MINOCA. Identification of the underlying cause in a case of MINOCA has therapeutic implications. While long-term management of MINOCA is not standardized, angiotensin converting enzyme inhibitors and statins appear to be of benefit. In this review, we discuss the prevalence and pathophysiology of MINOCA, diagnostic considerations, and current treatment approaches to manage this high-risk group of patients.
心肌梗死与非阻塞性冠状动脉疾病（MINOCA）被认为是导致男性和女性不良心血管结局的重要因素，在年轻女性中尤为普遍。多种冠状动脉机制，如冠状动脉斑块破裂、冠状动脉痉挛、冠状动脉微血管功能障碍、自发性冠状动脉夹层和冠状动脉血栓栓塞，均可引发MINOCA。除了常规的左心导管检查外，有创冠状动脉成像和心脏磁共振成像有助于明确MINOCA的病因。心肌炎、应激性心肌病和心肌病等情况在疑似MINOCA的患者中需鉴别作为其他解释。确定MINOCA病例的潜在病因具有治疗意义。虽然MINOCA的长期管理尚无标准化方案，但血管紧张素转换酶抑制剂和他汀类药物似乎有益。在本综述中，我们讨论了MINOCA的患病率和病理生理学、诊断考虑因素以及管理这一高危患者群体的当前治疗方法。
