- Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
- Term first assigned in 2013 to describe a common Coronary Angiography finding
- Positive biomarkers and MI findings with <50% coronary stenosis on angiography, and no alternative diagnosis
- MINOCA accounts for 15% of Myocardial Infarctions
- Female predominance (RR 5)
- Younger patients (mean age 61 years old)
- Ethnicity: More common in black and hispanic patients
- NSTEMI in 70-80% of cases
- Often lack typical CAD risk factors (e.g. Hypertension, Hyperlipidemia)
- However, many MINOCA patients do have Diabetes Mellitus or Obesity
- Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
- Positive cardiac biomarkers (e.g. Troponin) AND
- Clinical evidence of Myocardial Infarction AND
- No significant epicardial Coronary Artery stenosis on coronary angiogram (<50%) AND
- No alternative diagnosis for the MI presentation
- Coronary Artery Plaque Disruption
- Coronary Artery embolism or thrombosis
- Coronary Artery Vasospasm
- Coronary Microvascular Dysfunction
- Spontaneous Coronary Artery Dissection (SCAD)
- Takotsubo Cardiomyopathy
- Myocarditis
- Nonischemic Cardiomyopathy
- See Takotsubo Cardiomyopathy
- See Spontaneous Coronary Artery Dissection
- See Myocarditis
- See Coronary Artery Vasospasm
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General Measures
- Treat based on underlying cause
- Tobacco Cessation
- Cardiac Rehabilitation
- Avoid stimulants (e.g. Cocaine, Methamphetamines, pseudophedrine)
- Avoid other triggering medications (e.g. Triptans)
-
Coronary Artery
Plaque Disruption is treated in similar way to obstructive coronary disease (but without stenting)
- Aspirin (or Dual Antiplatelet Therapy)
- High Intensity Statin
- Left Ventricular Dysfunction
- Coronary embolism or thrombosis
- Antithrombotic agents (Anticoagulation)
- Address underlying mechanisms for Thrombophilia
- Coronary Microvascular Dysfunction
- Beta Blockers or Calcium Channel Blockers
- Long Acting Nitrates
- Consider Ranolazine as second-line agent