Riahi Farshad, Tooyserkani Seyed-Hamed, Mojahedi Azad, Dormiani-Tabatabaei Seyed-Amirhossein, Fesharaki Shahin, Azizollahi Sara, Sourani Armin, Khansari Mahmoud, Alaei Maryam, Ghazanfari-Hashemi Mohamad, Vakili-Zarch Milad, Sadeghian Amirhossein, Hosseini Sahar, Miratashi-Yazdi Seyedeh-Nooshin
Department of Radiology, Isfahan University of Medical Sciences Isfahan, Iran.
School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran.
Am J Cardiovasc Dis. 2025 Apr 25;15(2):56-68. doi: 10.62347/FCDC4114. eCollection 2025.
Myocardial infarction with non-obstructed coronary arteries (MINOCA) occurs when patients experience a heart attack without significant coronary artery blockage despite showing acute coronary syndrome symptoms. Unlike stable atherosclerosis, MINOCA involves acute myocardial infarction (MI) without obstructive coronary artery disease (CAD). The diagnostic criteria included meeting the universal MI definition, non-obstructive coronary arteries on angiography (< 50% stenosis), and no apparent cause of the acute event. The causes include coronary, cardiac, and extracardiac origins, such as plaque rupture, coronary spasm, myocarditis, or pulmonary embolism. MINOCA affects 5-6% of patients with acute MI undergoing angiography, with variations based on demographic factors. Although MINOCA was initially believed to have a favorable outcome, recent findings have indicated that MINOCA patients have a worse prognosis than the general population. Current guidelines strongly advocate the use of cardiac magnetic resonance imaging (CMR) to evaluate suspected MINOCA cases. However, multiple studies have demonstrated that CMR may fail to detect some instances of MINOCA, particularly in cases of mild inflammation or minor infractions. This could lead to a false-negative diagnosis requiring further testing. This review aimed to evaluate the diagnostic and prognostic value of CMR in patients with potential MINOCA.
非阻塞性冠状动脉心肌梗死（MINOCA）发生于患者虽表现出急性冠状动脉综合征症状，但在无明显冠状动脉阻塞的情况下发生心脏病发作时。与稳定型动脉粥样硬化不同，MINOCA涉及无阻塞性冠状动脉疾病（CAD）的急性心肌梗死（MI）。诊断标准包括符合通用的MI定义、血管造影显示冠状动脉无阻塞（狭窄<50%）以及急性事件无明显病因。病因包括冠状动脉、心脏和心外源性，如斑块破裂、冠状动脉痉挛、心肌炎或肺栓塞。MINOCA影响5%至6%接受血管造影的急性MI患者，因人口统计学因素而有所差异。尽管MINOCA最初被认为预后良好，但最近的研究结果表明，MINOCA患者的预后比一般人群更差。当前指南强烈主张使用心脏磁共振成像（CMR）来评估疑似MINOCA病例。然而，多项研究表明，CMR可能无法检测到某些MINOCA病例，尤其是在轻度炎症或轻微梗死的情况下。这可能导致假阴性诊断，需要进一步检查。本综述旨在评估CMR对潜在MINOCA患者的诊断和预后价值。
