Page 42 - BH-3-3

Brain & Heart A review on MINOCA

endothelial cells, resulting in thrombosis, is referred to as coronary spasm was associated with a higher risk of long-
an eroded plaque. Research has shown that 38 – 40% of term mortality (32.4% vs. 4.7%, p=0.002). 26
individuals with MINOCA who undergo intracoronary
imaging show signs of plaque disruption, such as erosion, 4.4. Coronary artery embolism
14
calcified nodules, or plaque rupture. Using intravascular When managing patients with MI and risk factors
ultrasonography (IVUS), Reynolds et al. studied 42 for thromboembolism, clinicians should consider the
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women with MINOCA; 38% of the patients showed signs possibility of coronary artery embolism. The risk factors
27
of plaque disruption. Out of them, four patients had include atrial fibrillation, prosthetic valves, atrial septal
plaque ulceration, and 12 patients had plaque rupture. defect, left-sided valvular disease, intracardiac tumors,
The information reported by Hong et al. who conducted thrombophilia (factor V Leiden, deficiency of proteins
16
a three-vessel IVUS investigation in patients with acute C and S, factor XII deficiency), and systemic lupus
coronary syndrome (ACS) or stable angina is in line erythematosus. 28,29 Transesophageal echocardiography
with these data. In patients with ACS and stable angina, should be performed to evaluate the underlying cause.
the prevalence of plaque rupture was 68% and 30%,
respectively. However, the percentage of plaque disruption 5. Prognosis
was similar in MINOCA patients on both optical coherence MINOCA has several causes, and its prognosis is linked
tomography (OCT) and cardiac magnetic resonance to the underlying cause. According to a systematic review,
imaging (CMR) tests. 17-20 patients with MINOCA had a 12-month all-cause mortality
rate of 4.7%. 30,31 Patients with MINOCA have a high risk
4.2. SCAD
of adverse outcomes, according to a meta-analysis of
SCAD is characterized by a non-traumatic separation of the clinical manifestations and prognosis of MINOCA
the coronary artery wall layers resulting in an intramural and MI-CAD. According to one study, the death rate
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hematoma. This intramural hematoma results in decreased for MINOCA patients was 3.8% following a 25-month
arterial blood flow and MI. SCAD affects about 20% of follow-up. Although MINOCA has a better long-term
MINOCA patients, and it is associated with pregnancy, prognosis compared to MI-CAD, it is not a benign
fibromuscular dysplasia, female gender, peripartum condition. A study conducted on 14,045 MINOCA patients
state, and younger age. SCADs often heal on their own. revealed 30-day mortality greater than that of MI-CAD
21
Studies using observational data have demonstrated that patients (4.48% versus 3.46%). The GENESIS-PRAXIS
angiographic “healing” of SCAD lesions occurs in between study showed that MINOCA patients have high-risk
70% and 97% of the instances. After the 1 month, features despite the lack of obstructive CAD. Nonetheless,
22
st
healing is frequently observed and tends to happen a Korean MI registry analysis found that patients with
early, mostly within days. The key diagnostic method is MINOCA had a 1-year all-cause mortality rate similar
23
coronary angiography, and despite the inability to image to CAD patients. However, a large-scale Italian study
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the artery wall, angiography illustrates several disease revealed that at 26-month follow-up, mortality rate, stroke,
features specific to SCAD. Three forms of SCAD can and readmission due to cardiogenic causes were similar in
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be distinguished from the angiographic pattern. Type 1 MI-CAD and MINOCA patients. Patients with MINOCA
3
lesions are characterized by a twofold lumen image; type 2 have worse short- and long-term survival rates than people
lesions are defined by a protracted lumen narrowing, which in general. Interestingly, a Chinese study showed no
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is typically more than 20 mm in length, whereas type 3 significant difference in mortality rate at 1-year follow-up
lesions resemble atherosclerotic lesions due to an abrupt despite a reduced frequency of major adverse cardiac events
focal constriction (lesion length <20 mm). 24,25 The most in MINOCA patients compared to MI-CAD patients. 35
often reported angiographic appearance in the Saw et al.
SCAD registry was type 2 (67.0% of patients), followed by 6. Diagnosis and detection tools
type 1 in 29% of cases and type 3 in 3.9% of cases. 25 During the initial evaluation of patients with suspected
AMI and non-obstructive CAD, it is critical to thoroughly
4.3. Coronary vasospasm
evaluate the clinical context and rule out clinically obvious
Coronary artery vasospasm is a frequent cause of sources of myocardial injury. If AMI is still the preferred
MINOCA. The predominant hosts include Asian clinical diagnosis, investigations should be used to rule
populations; however, frequency varies substantially. out clinically mild non-ischemic processes of myocardial
Epicardial or microvascular coronary spasm was reported necrosis, and obstructive causes of CAD should be ruled
in 24 – 70% of MINOCA patients after provocative testing out by reexamining the angiography. CMR is the main
with intracoronary acetylcholine or ergonovine. Any approach to studying MINOCA, as it provides imaging
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Volume 3 Issue 3 (2025) 3 doi: 10.36922/bh.5811