Myocardial Infarction with Nonobstructive Coronary Arteries (МINОСА) – a Trendy Term or a New Diagnostic Concept?
Abstract
The new term «MINOCA» (myocardial infarction with nonobstructive coronary arteries) emerged in the literature about 5 years ago and characterizes the syndrome with heterogeneous etiology and pathogenesis, which reflects the development of myocardial infarction with non-obstructive lesions of the coronary arteries, occurring in both cardiological and noncardiac diseases. The article gives detail focus on origin, definition, pathological bases of MINOCA. It also examines the role of coronary (non-obstructive atherosclerosis, microvascular dysfunction, coronary spasm, "myocardial bridge", coronary arteries dissection) and non-coronary reasons, caused by cardiac (cardiomyopathy, myocarditis) and non-cardiac (pulmonary embolism, thrombophilia) diseases.
In analyses of publications much attention is given to the discussion of diagnosis and differential diagnosis, prognosis and treatment of MINOCA. Recommended methods of examination are given depending on the alleged cause of the occurrence of MINOCA. Two clinical cases demonstrated difficulty in diagnosis of this condition and the importance of an individual approach. Attention is also given to the absence of currently clinical guidelines for the management of patients with MINOCA and to the significant differences in the use of different classes of cardiotropic drugs according to different author’s mind.
Author gives the opinion that MINOCA has a certain practical significance as a preliminary "diagnosis" before final establishing the disease. In conclusion, it is emphasized that the MINOCA syndrome terminology and characteristic is controversial now. This mind confirmed by a new definition of this condition in the Forth Universal Definition of Myocardial Infarction (European Society of Cardiology, 2018).
About the Author
S. S. Yakushin
I.P. Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Sergey S. Yakushin – MD, PhD, Professor, Head of Chair of Hospital Therapy.
Vysokovoltnaya ul. 9, Ryazan, 390026.
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Review
For citations:
Yakushin S.S. Myocardial Infarction with Nonobstructive Coronary Arteries (МINОСА) – a Trendy Term or a New Diagnostic Concept? Rational Pharmacotherapy in Cardiology. 2018;14(5):765-773. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-5-765-773
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