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Brain & Heart A review on MINOCA

evidence of AMI and rules out myocarditis, takotsubo of evidence-based literature about the management
syndrome, and cardiomyopathies. of MINOCA. Given the therapeutic shortcomings, it
During diagnostic coronary angiography, IVUS or is important to precisely define the treatment plan for
OCT, care should be taken into consideration to detect patients with MINOCA. Secondary preventive therapy is
the atherosclerotic culprit lesion. OCT and, to a lesser part of management for patients diagnosed with AMI due
to CAD (AMI-CAD; ST-segment elevation and non-ST-
extent, IVUS are important diagnostic techniques for segment elevation MI). ACE inhibitors, statins, β-blockers,
identifying coronary plaque disruption, spontaneous angiotensin receptor blockers (ARBs), dual antiplatelet
coronary dissection, and coronary thrombosis. As IVUS drugs, and cardiac rehabilitation are examples of typical
is unable to detect plaque erosion, OCT is the suggested cardioprotective measures. The atherothrombotic process
intravascular imaging technique. Reynolds et al. reported is the focus of the secondary preventive medicines.
17
that 46.2% of the 145 women who took part in the trial had Nonetheless, the atherosclerotic burden is negligible in
plaque rupture identified by OCT. They also discovered MINOCA patients, raising concerns about the necessity
that multimodality imaging and biomarkers were more of using some of these treatments on a regular basis.
successful than either modality alone in identifying the Accordingly, patients with MINOCA should have these
underlying cause of MINOCA (Figure 1). 17 therapies evaluated individually. It is recommended that

7. Management of MINOCA antiplatelet drugs and statins should be prescribed to
patients with MINOCA due to plaque disruption (type 1
Management of AMI due to obstructive CAD is AMI); however, their use in type 2 AMI is questionable
well established for both ST-segment-elevation and and may be contraindicated (e.g., β-blockers in patients
non-ST-segment-elevation MI. However, there is a dearth with coronary spasm).

Figure 1. Biomarkers in MINOCA. Image created by the authors.
Abbreviations: ADMA: Asymmetric dimethylarginine; MINOCA: Myocardial infarction with non-obstructive coronary arteries.

Volume 3 Issue 3 (2025) 4 doi: 10.36922/bh.5811