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Brain & Heart A review on MINOCA

beta-blockers can exacerbate the severity of spasm, they Funding
may not be recommended in patients with MINOCA and
myocardial bridging whose acetylcholine test indicates None.
epicardial or microvascular spasm. Instead, calcium channel Conflict of interest
blockers should be used for vasodilation. Ivabradine can
52
be used as a second-line drug, especially for patients who The authors declare no conflict of interest.
cannot take beta-blockers or calcium channel blockers.
Author contributions
Nonetheless, percutaneous coronary intervention
can be carried out in individuals with MINOCA due Conceptualization: Vicky Kumar
Visualization: Vicky Kumar, Haris Muhammad
to myocardial bridging-related atherosclerotic plaque Writing – original draft: Vicky Kumar, Haris Muhammad
rupture. Percutaneous coronary intervention in the Writing– review & editing: Ilsa Fatima, Joan Fallouh,
53
setting of myocardial bridging, however, may be difficult Rola Ali, Amer Hammad, Haris Usman, Oghenetejir
to perform and pose a greater short- and long-term risk. Gbegbaje

9. Conclusion Ethics approval and consent to participate
MINOCA affects up to 15% of patients with a presentation Not applicable.
of AMI, occurring in a younger population who are
less likely to have typical cardiovascular risk factors Consent for publication
and with a large female predominance. The condition
is defined by acute myocardial injury with an absence Not applicable.
of significant coronary artery stenosis and represents a Availability of data
diagnostic challenge, as the condition encompasses both
type 1 and type 2 MI and can appear clinically similar Not applicable.
to other conditions that cause non-ischemic myocardial References
injury, such as takotsubo cardiomyopathy or myocarditis.
The diagnosis of MINOCA requires diagnosis of AMI 1. Rossler C, Morbidoni J, Santillán ME, et al. Myocardial
according to universal MI criteria, with non-obstructive infarction without coronary arteries lesions. Insights
coronary disease as demonstrated by coronary angiography from the CONAREC XVII registry. Medicina (B Aires).
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acute presentation other than MI. The pathophysiological 2. Savran SV, Bryson AL, Welch TG, Zaret BL, McGowan RL,
mechanisms contributing to MINOCA are diverse, ranging Flamm MD Jr. Clinical correlates of coronary
from plaque disruption and SCAD to non-cardiac causes cineangiography in young males with myocardial infarction.
such as pulmonary embolism, sepsis, and shock. This Am Heart J. 1976;91(5):551-555.
heterogeneity necessitates a cause-specific diagnostic plan doi: 10.1016/S0002-8703(76)80138-X
with coronary angiography to exclude obstructive CAD in 3. Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF.
addition to transesophageal echocardiogram and imaging Systematic review of patients presenting with suspected
techniques such as CMR and OCT to identify underlying myocardial infarction and nonobstructive coronary arteries.
causes such as coronary vasospasm. The management Circulation. 2015;131(10):861-870.
is also cause-specific. Pharmacological therapy with doi: 10.1161/CIRCULATIONAHA.114.011201
beta-blockers, statins, ACE inhibitors/ARBs, and dual 4. Bainey KR, Welsh RC, Alemayehu W, et al. Population-level
antiplatelets has been shown to be beneficial, however, to incidence and outcomes of myocardial infarction with non-
different extents in each specific MINOCA population. obstructive coronary arteries (MINOCA): Insights from the
Prognosis for MINOCA patients varies considerably Alberta contemporary acute coronary syndrome patients
based on the underlying etiology and degree of myocardial invasive treatment strategies (COAPT) study. Int J Cardiol.
injury. While recent studies suggest that MINOCA 2018;264:12-17.
generally carries a better long-term prognosis compared doi: 10.1016/j.ijcard.2018.04.004
to obstructive CAD, 37,38,40 there is a notable incidence of
adverse outcomes such as MI recurrence. 5. Kilic S, Aydın G, Çoner A, et al. Prevalence and clinical
profile of patients with myocardial infarction with non-
Acknowledgments obstructive coronary arteries in turkey (MINOCA-TR):
A national multi-centre, observational study. Anatol J
None. Cardiol. 2020;23(3):176-182.

Volume 3 Issue 3 (2025) 6 doi: 10.36922/bh.5811