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Brain & Heart

REVIEW ARTICLE
Myocardial infarction with non-obstructive

coronary arteries: A review

2
1
Vicky Kumar * , Haris Muhammad , Ilsa Fatima , Joan Fallouh , Rola Ali ,
3
4
5
Amer Hammad , Aparna Iyer , Ali Athar , Haris Usman , Oghenetejir
6
7
2
6
Gbegbaje , and Hafeez Ul Hassan Virk 8
6
1 Department of Internal Medicine, Dow Medical College, Karachi, Pakistan
2 Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, United States
of America
3 Department of Internal Medicine, Service Institute of Medical Sciences, Lahore, Pakistan
4 Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
5 Department of Internal Medicine, Advent Health, Orlando, Florida, United States of America
6 Department of Internal Medicine, Englewood Health/Hackensack University, Englewood, New
Jersey, United States of America
7 Department of Internal Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
8 Department of Cardiology, Adena Regional Medical Center, Chillicothe, Ohio, United States of
America

Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCAs) affects
*Corresponding author: about 15% of patients diagnosed with myocardial infarction (MI). Patients with
Vicky Kumar MINOCA often lack significant cardiac risk factors such as diabetes mellitus, cigarette
(vicky.kumar@gwu.edu)
smoking, and hypertension. Notable, MINOCA is common among female individuals,
Citation: Kumar V, Muhammad H, often occurring in younger women. This highlights the importance of considering
Fatima I, et al. Myocardial infarction
with non-obstructive coronary MINOCA in women presenting with symptoms suggestive of MI, even in the absence
arteries: A review. Brain & Heart. of conventional risk factors. Precisely, MINOCA is not a distinct disease entity but
2025;3(3):5811. rather a working diagnosis which necessitates further evaluation. MINOCA results
doi: 10.36922/bh.5811 from a heterogeneous group of conditions that ultimately result in ischemic injury to
Received: November 7, 2024 the myocardium and causes can be cardiac (e.g., coronary embolism) or non-cardiac
1st revised: March 30, 2025 (e.g., sepsis). Diagnosis involves coronary angiography to rule out obstructive coronary
artery disease (CAD) and transesophageal echocardiography for the assessment of
2nd revised: April 29, 2025 regional wall motion abnormalities. Cardiovascular magnetic resonance imaging
Accepted: May 7, 2025 can be performed to rule out acute myocarditis or takotsubo cardiomyopathy, which
Published online: May 22, 2025 is non-ischemic cause of myocardial injury in MINOCA. Management of MINOCA is
specific to the underlying cause and usually influenced by the degree of myocardial
Copyright: © 2025 Author(s).
This is an Open-Access article damage, and the prognosis is variable and depends largely on the underlying
distributed under the terms of the etiology. While some studies suggest that MINOCA patients may have a better short-
Creative Commons Attribution term prognosis compared to those with MI and obstructive CAD, they still face a
License, permitting distribution,
and reproduction in any medium, significant risk of long-term adverse cardiovascular events, including recurrent MI,
provided the original work is heart failure, stroke, and death. Identifying the specific causes of MINOCA is crucial for
properly cited. accurate risk stratification and tailored management to improve patient outcomes.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Ischemic heart disease; Myocardial infarction; Non-obstructive coronary
regard to jurisdictional claims in
published maps and institutional artery disease
affiliations.

Volume 3 Issue 3 (2025) 1 doi: 10.36922/bh.5811