Tani Kenichi, Kurihara Osamu, Shirakabe Akihiro, Kobayashi Nobuaki, Takano Masamichi, Asai Kuniya
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
J Geriatr Cardiol. 2024 Dec 28;21(12):1133-1140. doi: 10.26599/1671-5411.2024.12.007.
Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.
临床表现为无血管造影显示中度至重度狭窄（>50%）且无任何其他相关诊断的心肌梗死被定义为冠状动脉非阻塞性心肌梗死（MINOCA）。MINOCA初步诊断的常见病因包括斑块破裂、自发性冠状动脉夹层、冠状动脉痉挛、冠状动脉血栓栓塞、应激性心肌病和心肌炎。临床病史、心肌酶检测、心电图、超声心动图、冠状动脉造影和左心室造影有助于MINOCA的初步诊断并揭示潜在病因，而心血管磁共振和光学相干断层扫描（OCT）则用于确诊。尽管心血管磁共振是MINOCA的金标准无创诊断工具，但由于其图像分辨率，其诊断冠状动脉中这种情况的病因和机制的能力有限。观察性研究表明，OCT可通过研究罪犯病变的特征来确定MINOCA的潜在病因，并预测患者的预后。在本文中，我们回顾了当前针对MINOCA的诊断方法，重点关注每种成像工具。此外，我们重新评估了OCT在MINOCA临床管理中的作用。通过OCT确定MINOCA的病因可能有助于选择最佳有效的药物治疗并改善预后。
