Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) sometimes remain unclear about whether they had an acute MI. Clinicians can assist by clarifying the underlying pathophysiology responsible for the ‘working diagnosis’ of MINOCA.
- Some patients with acute myocardial infarction (MI) do not have obstructive coronary artery disease; the term MINOCA (myocardial infarction with nonobstructive coronary arteries) was coined to describe such patients.
- MINOCA should be considered a ‘working diagnosis’ as ischaemic versus nonischaemic causes are initially delineated and the mechanism for the ischaemic infarction is subsequently identified.
- Potential ischaemic causes are diverse, including coronary plaque disruption, occult coronary dissection, coronary thrombosis/embolism, coronary spasm (spontaneous or drug-induced) and coronary microvascular dysfunction.
- The underlying cause may influence the choice of therapy; however, use of conventional postinfarction cardioprotective therapies in patients with MINOCA is still under investigation.