Myocardial infarction with no obstructive coronary atherosclerosis
- Filippo Crea, MD
Filippo Crea, MD
- Professor of Cardiology
- Department of Cardiovascular Medicine
- Catholic University Rome
- Giampaolo Niccoli, MD, PhD
Giampaolo Niccoli, MD, PhD
- Assistant Professor of Cardiology
- Catholic University of the Sacred Heart
- Section Editor
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
Most cases of acute myocardial infarction (MI) are caused by rupture or erosion of a fixed atherosclerotic plaque associated with subsequent thrombus formation . Other causes include a supply-demand mismatch in the presence of a significant fixed atherosclerotic obstruction. Atherosclerotic lesions causing MI as a result of plaque disruption or erosion are not necessarily severe and different degrees of obstruction can be seen on coronary arteriography in most cases. (See "The role of the vulnerable plaque in acute coronary syndromes" and "Angina pectoris: Chest pain caused by myocardial ischemia", section on 'Pathophysiology of myocardial ischemia' and "Pathology and pathogenesis of the vulnerable plaque".)
This topic will discuss the potential causes of MI that occur in the absence of obstructive atherosclerosis.
Myocardial infarction (MI) is identified by the detection of "rise and/or fall" of troponin associated with at least one of the following: symptoms of myocardial ischemia, electrocardiographic changes indicative of new ischemia, evidence of new loss of viable myocardium or new regional wall motion abnormality, and identification of intracoronary thrombus by angiography or autopsy . (See "Criteria for the diagnosis of acute myocardial infarction", section on 'Third universal definition of MI'.)
MI with no obstructive coronary atherosclerosis (MINOCA) is a distinct clinical syndrome characterized by evidence of MI with normal or near normal coronary arteries on angiography (stenosis severity ≤50 percent) . There are several well-defined causes/pathophysiologic mechanisms for MINOCA; the prognosis and management differs for each of these.
In a systematic review of studies, the prevalence of myocardial infarction with no obstructive coronary atherosclerosis among patients with acute myocardial infarction was between 1 and 14 percent with a mean of 6 percent . However, prevalence varied widely across the studies.
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- - Coronary artery spasm
- - Acute thrombosis at the site of non-obstructive eccentric plaque thrombosis
- - Takotsubo cardiomyopathy
- - Coronary microvascular dysfunction
- - Viral myocarditis
- Coronary artery embolism
- CLINICAL FEATURES
- DETERMINING THE CAUSE
- RECOMMENDATIONS OF OTHERS