Myocardial infarction with nonobstructive coronary arteries

MINORCA affects 5-10% of acute myocardial infarction patients who have minimal to no discernible high-grade critical coronary arterial stenosis.

Prevalence is dependent on the definition used, and it ranges between 1and 15%, with an overall prevalence of 6% in a meta-analysis.

The majority of these patients are postmenopausal females.

Appropriate therapy remains unclear.

Patients with MINOCA frequently have manifestations of atherosclerotic disease and other areas, such as peripheral vascular disease.

Approximately 14% die during a 4.5 year follow up.

Suggested pathophysiologic mechanisms include: transient coronary arterial spasm, coronary arterial embolization, endothelial dysfunction, coronary arterial dissection, takotsubo event and occlusion of a small coronary arterial branch overlooked at angiography.

Majority of patients are older women with significant atherosclerosis risk factors including: diabetes, hypertension, and hyperlipidemia.

SWEDEHEART study revealed approximately 6% of patients with MINOCA subsequently suffer a second myocardial infarction, and angiography at that time reveals that half of the patients had developed clinically important coronary arterial stenosis.

In the above study 22% of patients who developed a re-infarction die during a 2.3 year follow-up and a half of the deaths were cardiovascular.

Personality traits are not likely to be associated with MINOCA.

Mortality associated with current events is substantial, although there is no difference in mortality between those with or without significant coronary artery disease.

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