In the past decade, scientific and clinical research has provided a translational perspective on
myocardial infarction (MI) with non-obstructive coronary arteries (
MINOCA).
MINOCA is characterized by clinical documentation of an acute MI but angiography shows no significant coronary artery obstruction (
stenosis <50%). The prevalence of
MINOCA is estimated to range from approximately 6 to 10% among MI patients, and those with this condition have a poor prognosis, experiencing high rates of mortality,
rehospitalization, and socioeconomic burden.
MINOCA represents a major unmet need in cardiovascular medicine, with uncertain clinical management. It is a complex condition that can be caused by various factors, including
atherosclerosis, plaque
rupture,
coronary vasospasm, and microvascular dysfunction. Effective management of
MINOCA depends on identifying the underlying mechanism of the
infarction, thus a systematic diagnostic approach is recommended. Contemporary data shows that a significant number of patients exhibit structural and functional abnormalities in coronary microcirculation, which is referred to as coronary microvascular dysfunction (CMD). CMD plays a crucial role in patients with signs and symptoms of
myocardial ischemia and non-obstructive
coronary artery stenosis, including
MINOCA. Furthermore, conducting a thorough evaluation of coronary function can have significant prognostic and therapeutic implications, since personalized patient management strategies based on this assessment have been shown to improve symptoms and prognosis. Therefore, an accurate and timely diagnosis of CMD is essential for effective patient management, which can be achieved through various invasive and non-invasive methods. This review will discuss the pathophysiological understanding, current diagnostic techniques, and management strategies of patients with
MINOCA and CMD.