IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311379
Open Access Systematic Review
Myocardial Infarction with Non-Obstructive Coronary Arteries: A Puzzle in Search of a Solution
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1 Cardiovascular Disease Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, 16132 Genoa, Italy
*Correspondence: (Riccardo Scagliola)
Academic Editors: John Lynn Jefferies and Salvatore De Rosa
Rev. Cardiovasc. Med. 2022, 23(11), 379;
Submitted: 12 June 2022 | Revised: 22 September 2022 | Accepted: 17 October 2022 | Published: 9 November 2022
(This article belongs to the Special Issue The Pathophysiology of Acute Coronary Syndromes)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: The term myocardial infarction with non-obstructive coronary arteries (MINOCA), defines a puzzling event occurring in the absence of obstructive coronary artery disease on coronary angiography and without an overt potential cause. However, a practical diagnostic work-up is often difficult, due to the heterogeneous etiologies and pathophysiology of MINOCA. This review aims to provide a comprehensive overview focusing on epidemiology, etiopathogenesis, diagnostic tools and therapeutic strategies for subjects with MINOCA, in order to provide a prompt and accurate diagnostic work-up and an adequate therapeutic approach in this subset population. Methods: This educational review was carried out by following the standard methods of the Cochrane Collaboration and the PRISMA statement. The terms “MINOCA” OR (“myocardial infarction” AND (“non-obstructive” OR “non-obstructive”)) were searched in PubMed and Embase databases (in Title and/or Abstract) from 1st January 2003 until 31st May 2022. Results: Etiologic findings, clinical presentation and the degree of hemodynamic impairment play a pivotal role in defining the patient’s natural history and prognostic outcome, and may significantly impact on the decision-making strategies and therapeutic approaches. Conclusions: Despite further advances in diagnostic and therapeutic strategies, MINOCA remains a challenging conundrum in clinical practice. Clinicians should be aware of the different potential etiologies and pathogenic mechanisms of MINOCA, in order to carry out a comprehensive diagnostic work-up and implement a tailored therapeutic approach.

epicardial etiologies
microvascular etiologies
diagnostic tools
therapeutic strategies
Fig. 1.
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