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Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 January 2024) | Viewed by 24321

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Special Issue Editors

Dr. Giuseppe Ciliberti

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Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy
Interests: MINOCA; ECG; acute coronary syndromes; cardiomyopathies
Special Issues, Collections and Topics in MDPI journals

Dr. Rocco Montone

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Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
Interests: MINOCA; acute coronary syndrome; optical coherence tomography; coronary microvascular dysfunction

Dr. Sivabaskari Pasupathy

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Guest Editor

School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
Interests: myocardial infarction with non obstructive coronary arteries (MINOCA); angina with non obstructive coronary arteries (ANOCA); cardiac magnetic resonance imaging; coronary artery disease; heart failure; cardiomyopathies
Special Issues, Collections and Topics in MDPI journals

Dr. Carmine Pizzi

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1. Department of Medical and Surgical Sciences—DIMEC, University of Bologna, Bologna, Italy
2. IRCCS S. Orsola Hospital, 40138 Bologna, Italy
Interests: clinical cardiology; acute myocardial infarction; chronic coronary syndrome; non-invasive imaging; preventive cardiology
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Special Issue Information

Dear Colleagues,

We are very pleased to announce the upcoming release of a Special Issue of the Journal of Clinical Medicine focused on Myocardial Infarction and Non-Obstructed Coronary Arteries (MINOCA).

MINOCA recognition has been gaining ground in recent years thanks to increased awareness of this condition and the presence of powerful diagnostic tools, such as ultrasensitive biomarkers of myocardial injury.

Although there is an increasing interest from clinicians all around the world regarding MINOCA, its management still represents a challenge and many aspects remain controversial.

In fact, research on MINOCA has dramatically improved in the last few years, but there are many unresolved issues, especially those pertaining to diagnostic and therapeutic approaches.

A “precision medicine” approach is required to manage these patients, and this dedicated Special Issue of the Journal of Clinical Medicine represents a unique opportunity to disseminate your research in the intriguing field of MINOCA.

…

Dr. Giuseppe Ciliberti
Dr. Rocco Montone
Dr. Sivabaskari Pasupathy
Prof. Dr. Carmine Pizzi
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

MINOCA
myocardial infarction
acute coronary syndrome
coronary arteries
coronary artery disease
ischemic cardiac disease

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Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions: 2nd Edition in Journal of Clinical Medicine

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Research

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16 pages, 2967 KiB

Open AccessArticle

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

by Mustafa Kacmaz, Clara Schlettert, Fabienne Kreimer, Mohammad Abumayyaleh, Ibrahim Akin, Andreas Mügge, Assem Aweimer, Nazha Hamdani and Ibrahim El-Battrawy

J. Clin. Med. 2024, 13(10), 2826; https://doi.org/10.3390/jcm13102826 - 11 May 2024

Viewed by 1170

Abstract

Background: The development and course of myocardial infarction with non-obstructive coronary artery (MINOCA) disease is still not fully understood. In this study, we aimed to examine the baseline characteristics of in-hospital outcomes and long-term outcomes of a cohort of troponin-positive patients without obstructive coronary artery disease based on different left ventricular ejection fractions (LVEFs). Methods and results: We included a cohort of 254 patients (mean age: 64 (50.8–75.3) years, 120 females) with suspected myocardial infarction and no obstructive coronary artery disease (MINOCA) in our institutional database between 2010 and 2021. Among these patients, 170 had LVEF ≥ 50% (84 females, 49.4%), 31 patients had LVEF 40–49% (15 females, 48.4%), and 53 patients had LVEF < 40% (20 females, 37.7%). The mean age in the LVEF ≥ 50% group was 61.5 (48–73) years, in the LVEF 40–49% group was 67 (57–78) years, and in the LVEF < 40% group was 68 (56–75.5) years (p = 0.05). The mean troponin value was highest in the LVEF < 40% group, at 3.8 (1.7–4.6) µg/L, and lowest in the LVEF ≥ 50% group, at 1.1 (0.5–2.1) µg/L (p = 0.05). Creatine Phosphokinase (CK) levels were highest in the LVEF ≥ 50% group (156 (89.5–256)) and lowest in the LVEF 40–49% group (127 (73–256)) (p < 0.05), while the mean BNP value was lowest in the LVEF ≥ 50% group (98 (48–278) pg/mL) and highest in the <40% group (793 (238.3–2247.5) pg/mL) (p = 0.001). Adverse in-hospital cardiovascular events were highest in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group (56% vs. 55% vs. 27%; p < 0.001). Over a follow-up period of 6.2 ± 3.1 years, the all-cause mortality was higher in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group. Among the different factors, LVEF < 40% and LVEF 40–49% were associated with an increased risk of in-hospital cardiovascular events in the multivariable Cox regression analysis. Conclusions: LVEF has different impacts on in-hospital cardiovascular events in this cohort. Furthermore, LVEF influences long-term all-cause mortality. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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12 pages, 1043 KiB

Open AccessEditor’s ChoiceArticle

Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older Adults

by Ana Gabaldon-Perez, Clara Bonanad, Sergio Garcia-Blas, Víctor Marcos-Garcés, Jessika Gonzalez D’Gregorio, Agustín Fernandez-Cisnal, Ernesto Valero, Gema Minana, Héctor Merenciano-González, Anna Mollar, Vicente Bodi, Julio Nunez and Juan Sanchis

J. Clin. Med. 2023, 12(3), 1181; https://doi.org/10.3390/jcm12031181 - 2 Feb 2023

Cited by 8 | Viewed by 2327

Abstract

A non-neglectable percentage of patients with non-ST elevation myocardial infarction (NSTEMI) show non-obstructive coronary arteries (MINOCA). Specific data in older patients are scarce. We aimed to identify the clinical predictors of MINOCA in older patients admitted for NSTEMI and to explore the long-term prognosis of MINOCA. This was a single-center, observational, consecutive cohort study of older (≥70 years) patients admitted for NSTEMI between 2010 and 2014 who underwent coronary angiography. Univariate and multivariate Cox regression were performed to analyze the association of variables with MINOCA and all-cause mortality and with major adverse cardiac events (MACE), defined as a combined endpoint of all-cause mortality and nonfatal myocardial infarction and a combined endpoint of cardiovascular mortality, nonfatal myocardial infarction, and unplanned revascularization. The registry included 324 patients (mean age 78.8 ± 5.4 years), of which 71 (21.9%) were diagnosed with MINOCA. Predictors of MINOCA were female sex, left bundle branch block, pacemaker rhythm, chest pain at rest, peak troponin level, previous MI, Killip ≥2, and ST segment depression. Regarding prognosis, patients with obstructive coronary arteries (stenosis ≥50%) and the subgroup of MINOCA patients with plaques <50% had a similar prognosis; while MINOCA patients with angiographically smooth coronary arteries had a reduced risk of MACE. We conclude that the following: (1) in elderly patients admitted for NSTEMI, certain universally available clinical, electrocardiographic, and analytical variables are associated with the diagnosis of MINOCA; (2) elderly patients with MINOCA have a better prognosis than those with obstructive coronary arteries; however, only those with angiographically smooth coronary arteries have a reduced risk of all-cause mortality and MACE. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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9 pages, 537 KiB

Open AccessCommunication

Underlying Causes of Myocardial Infarction with Nonobstructive Coronary Arteries: Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging Pilot Study

by Joanna Fluder-Wlodarczyk, Marek Milewski, Magda Roleder-Dylewska, Maciej Haberka, Andrzej Ochala, Wojciech Wojakowski and Pawel Gasior

J. Clin. Med. 2022, 11(24), 7495; https://doi.org/10.3390/jcm11247495 - 17 Dec 2022

Cited by 3 | Viewed by 1575

Abstract

Background: Scientific statements recommend multimodality imaging in myocardial infarction with non-obstructive coronary arteries (MINOCA) to define the underlying cause. Aim: We evaluated the diagnostic yield of intravascular optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) in the MINOCA setting. Methods: In this prospective, single center, observational pilot study, we enrolled patients with MINOCA without previous coronary interventions. All patients underwent three vessel OCT, followed by CMR. Imaging results were combined to determine the mechanism of MINOCA, when possible. Results: We enrolled 10 patients in this pilot study. Women constituted 50% of the analyzed population. The mean age of patients was 52 years. ST-segment elevation was found in 30% of patients. A possible culprit lesion was identified by OCT in 70% of participants, most commonly plaque rupture or erosion. An ischemic pattern of CMR abnormalities was identified in 70% of participants. Myocarditis and Tako-Tsubo were identified in 30%. A cause of MINOCA was identified in all patients using multimodality imaging, while using OCT alone identification occurred in only 70% of patients. Conclusion: In this pilot study, multimodality imaging with OCT and CMR identified potential mechanisms in all patients with a diagnosis of MINOCA, and it has the potential to guide medical therapy for secondary prevention. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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Review

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17 pages, 994 KiB

Open AccessReview

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

by Paolo Severino, Andrea D’Amato, Silvia Prosperi, Vincenzo Myftari, Lorenzo Colombo, Elisa Tomarelli, Alice Piccialuti, Gianluca Di Pietro, Lucia Ilaria Birtolo, Viviana Maestrini, Roberto Badagliacca, Gennaro Sardella, Francesco Fedele, Carmine Dario Vizza and Massimo Mancone

J. Clin. Med. 2023, 12(10), 3586; https://doi.org/10.3390/jcm12103586 - 21 May 2023

Cited by 12 | Viewed by 4665

Abstract

Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasingly recognized. Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor for the pathophysiology and prognosis of patients with MINOCA. Genetic susceptibility may have a role in primum movens in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential in order to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction. Progress in research would allow early identification of high-risk patients and the development of pharmacological, patient-tailored strategies. The aim of this review is to revise the pathophysiology and underlying mechanisms of MINOCA, focusing on CMD and actual knowledge about genetic predisposition to it. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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14 pages, 2432 KiB

Open AccessReview

Role of Intracoronary Imaging in Myocardial Infarction with Non-Obstructive Coronary Disease (MINOCA): A Review

by Irene Borzillo, Ovidio De Filippo, Rossella Manai, Francesco Bruno, Emanuele Ravetti, Alma Andrea Galanti, Rocco Vergallo, Italo Porto, Gaetano Maria De Ferrari and Fabrizio D’Ascenzo

J. Clin. Med. 2023, 12(6), 2129; https://doi.org/10.3390/jcm12062129 - 8 Mar 2023

Cited by 4 | Viewed by 2616

Abstract

Myocardial infarction with non-obstructive coronary artery disease occurs in 6% to 15% of all presentation of myocardial infarctions. The pathophysiologic mechanisms of MINOCA include epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, and coronary thrombus/embolism. The diagnosis is challenging, supported by intracoronary imaging with intravascular ultrasound (IVUS) and optical coherent tomography (OCT), coronary physiology testing, and cardiac magnetic resonance imaging (CMR). OCT is able to identify atherosclerotic causes of MINOCA (plaque erosion, plaque rupture, and calcified nodule) and nonatherosclerotic causes (spontaneous artery dissection, and spasm). In this review, we summarize the performance of the two intracoronary imaging modalities (IVUS and OCT) in MINOCA and discuss the importance of supplementing these modalities with CMR in order to drive target therapy. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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29 pages, 4313 KiB

Open AccessReview

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

by Lucas Lentini Herling de Oliveira, Vinícius Machado Correia, Pedro Felipe Gomes Nicz, Paulo Rogério Soares and Thiago Luis Scudeler

J. Clin. Med. 2022, 11(19), 5497; https://doi.org/10.3390/jcm11195497 - 20 Sep 2022

Cited by 6 | Viewed by 7581

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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Other

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9 pages, 726 KiB

Open AccessBrief Report

Characteristics and Prognosis of a Contemporary Cohort with Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) Presenting Different Patterns of Late Gadolinium Enhancements in Cardiac Magnetic Resonance Imaging

by Valentina Bucciarelli, Francesco Bianco, Alessia Di Francesco, Piergiusto Vitulli, Annaclara Biasi, Martina Primavera, Sara Belleggia, Giuseppe Ciliberti, Federico Guerra, Jelena Seferovic, Antonio Dello Russo and Sabina Gallina

J. Clin. Med. 2023, 12(6), 2266; https://doi.org/10.3390/jcm12062266 - 15 Mar 2023

Cited by 6 | Viewed by 2170

Abstract

Background: To analyze the characteristics and prognosis of a contemporary cohort of patients with myocardial infarction with non-obstructed coronaries (MINOCA) were referred for cardiac magnetic resonance (CMR) imaging, focusing on late gadolinium enhancement (LGE) patterns. Methods: We retrospectively examined and prospectively followed up with 135 patients (49 ± 21 years old, 48% female) undergoing CMR imaging due to a MINOCA diagnosis from 2014 to 2016. We grouped and analyzed the sample according to ischemic (focal or transmural) and non-ischemic LGE patterns. The primary outcome was cardiac-related death; the secondary outcome was a composite of cardiac-related rehospitalizations, the new occurrence of acute myocardial infarction (AMI), heart failure (HF), or arrhythmias. Results: CMR exams were performed after a median of 28 days from the acute event. One-third of the ischemic MINOCA were first managed as myocarditis, while CMR helped to adopt a different therapy regimen in 22% of patients (30/135). After a median follow-up of 2.3 years, more cardiac-related deaths occurred in the ischemic than non-ischemic group (2 vs. 1, p = 0.36), but it was not statistically significant. The ischemic group also experienced more cardiac-related-rehospitalizations (42%, p < 0.001). In a multivariable Cox regression model, dyslipidemia, reduced left ventricular ejection fraction, ST-elevation at the hospitalization, and the LGE transmural pattern were the independent predictors of cardiac-related rehospitalizations. Conclusions: In a contemporary cohort of MINOCA patients who underwent CMR, ischemic and non-ischemic patterns had distinct features and outcomes. Among the MINOCA patients, CMR can identify patients at higher risk who require more aggressive therapeutic approached and strict follow-up. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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