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Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

查看全文 作　　者：Rafael Vidal-[1]Perez;Charigan Abou Jokh [1]Casas;Rosa Maria Agra-[1,2]Bermejo;Belén Alvarez-[1,2]Alvarez;Julia [3]Grapsa;Ricardo Fontes-[4,5]Carvalho;Pedro Rigueiro [1,2]Veloso;Jose Maria Garcia [1]Acuña;Jose Ramon Gonzalez-[1,2]Juanatey 高影响力作者 机构地区：[1]Cardiology Department,Hospital Clinico Universitario de Santiago,Santiago de Compostela 15706,Spain;[2]Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares(CIBERCV),Santiago de Compostela 15706,Spain;[3]Cardiology Department,St Bartholomew Hospital,Barts Health Trust,London EC1A 7BE,United Kingdom;[4]Cardiology Department,Centro Hospitalar Gaia,Vila Nova Gaia 4434-502,Portugal;[5]Faculty of Medicine University of Porto,Porto 4200-319,Portugal高影响力机构 出　　处：《World Journal of Cardiology》索引2019年第11卷第12期,共11页高影响力期刊 摘　　要：Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients. 关 键 词：Myocardial infarction Non-obstructive coronary Myocardial infarction with non-obstructive coronary arteries Management PROGNOSIS
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