Myocardial infarction with non-obstructive coronary arteries (MINOCA) was first described over 80 years ago. The term has been widely and inconsistently used in clinical practice, influencing various aspects of disease classification, investigation and management. MINOCA encompasses a heterogenous group of conditions that include both atherosclerotic and non-atherosclerotic disease resulting in myocardial damage that is not due to obstructive coronary artery disease. In many ways, it is a term that describes a moment in the diagnostic pathway of the patient and is arguably not a diagnosis. Central to the definition is also the distinction between myocardial infarction and injury. The universal definition of myocardial infarction distinguishes acute myocardial infarction, including those with MINOCA, from other causes of myocardial injury by the presence of clinical evidence of ischaemia. However, these ischaemic features are often non-specific causing diagnostic confusion, and can create difficulties for patient management and follow-up. The purpose of this review is to summarise our current understanding of MINOCA and highlight important issues relating to the diagnosis, investigation and management of patients with MINOCA.
- myocardial infarction
- diagnostic imaging
- magnetic resonance imaging
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Contributors TS drafted the initial manuscript. ARC, MD, NLM and DEN contributed to manuscript and figure revisions and have authorised the final submission manuscript.
Funding TS is the author signing on behalf of all coauthors of the work. TS is supported by the British Heart Foundation (RE/18/5/34216) and Medical Research Council (MR/T-29/53/1). ARC receives support from a Starter Grant for Clinical Lecturers by the Academy of Medical Sciences (SGL021/1075). MD is supported by the British Heart Foundation (FS/14/78/31020). NLM is supported by the British Heart Foundation (FS/16/14/32023, RG/20/10/34966, RE/18/5/34216). DEN is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/18/5/34216) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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