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Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature

Received: 19 August 2021     Accepted: 3 September 2021     Published: 15 September 2021
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Abstract

Background: About 5-10% of all myocardial infarction patients undergoing diagnostic coronary angiography for typical chest pain have no significant coronary stenosis (stenosis severity <50%). We classified these patients as myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), which is characterized by both the diagnostic criteria of myocardial infarction and no significant coronary stenosis (stenosis severity <50%). The pathophysiology of MINOCA is multifactorial. Potential underlying mechanisms of MINOCA include coronary causes such as coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli, and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies; and noncardiac causes, for example, pulmonary embolism. Early secondary prophylaxis with drugs including statins and renin-angiotensin-aldosterone system inhibitors may be beneficial to prognosis. Objective: To report a case of MINOCA, analyze its clinical manifestations, imaging and related treatment, and improve the understanding of clinicians on MINOCA. Methods: A case of MINOCA diagnosed in the First Hospital of Hebei Medical University on June 8, 2021 was retrospectively analyzed. Clinical data related to clinical manifestations, examination results, diagnosis and treatment process were collected, and literatures related to non-obstructive myocardial infarction were reviewed to summarize its diagnosis and treatment characteristics. Results: The patient was a 73-year-old male, who was admitted to hospital for 8 hours due to sudden precardiac pain. After admission, relevant preoperative examination was completed, and preoperative electrocardiogram (ECG) and troponin examination results were considered as acute inferior wall myocardial infarction, percutaneous coronary angiography showed no significant narrowing of the coronary vessels and was diagnosed as MINOCA. The patient regularly applied drugs outside the hospital and was generally in good condition. He did not go to the hospital again. Conclusion: 1. MINOCA accounts for 5-10% of all MI patients, and a higher proportion of MINOCA patients are female. 2. It was previously believed that MINOCA patients had a good prognosis, but the incidence of major adverse cardiovascular events was still high in clinical work. The pathogenesis of MINOCA is complex and diverse, and early drug intervention and secondary prevention targeting the etiology can improve the prognosis of patients. 3. The clinical manifestations and characteristics of MINOCA patients were summarized in this case, the possible pathogenesis and treatment, so as to improve the understanding of this disease, screen high-risk groups for early intervention, and reduce the risk of adverse cardiovascular events in these patients.

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 3)
DOI 10.11648/j.ccr.20210503.15
Page(s) 153-156
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Myocardial Infarction, Non-obstructive, Coronary Artery Disease, Coronary Angiography, Case Report

References
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[2] Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European heart journal. 2021; 42 (14): 1289-1367.
[3] Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. European heart journal. 2015; 36 (8): 475-481.
[4] Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2018; 39 (2): 119-177.
[5] Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015; 131 (10): 861-870.
[6] Crea F, Niccoli G. Myocardial Infarction with Nonobstructive Coronary Atherosclerosis: The Need for Precision Medicine. JACC Cardiovascular imaging. 2019; 12 (11 Pt 1): 2222-2224.
[7] Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. European heart journal. 2017; 38 (3): 143-153.
[8] Eggers KM, Hadziosmanovic N, Baron T, et al. Myocardial Infarction with Nonobstructive Coronary Arteries: The Importance of Achieving Secondary Prevention Targets. Am J Med. 2018; 131 (5): 524-531 e526.
[9] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138 (20): e618-e651.
[10] Tamis-Holland JE, Jneid H, Reynolds HR, et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019; 139 (18): e891-e908.
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[14] Dastidar AG, Rodrigues JCL, Johnson TW, et al. Myocardial Infarction With Nonobstructed Coronary Arteries: Impact of CMR Early After Presentation. JACC Cardiovascular imaging. 2017; 10 (10 Pt A): 1204-1206.
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Cite This Article
  • APA Style

    Jie Chen, Wenjie Liang, Mei Wei, Mingqi Zheng, Gang Liu, et al. (2021). Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature. Cardiology and Cardiovascular Research, 5(3), 153-156. https://doi.org/10.11648/j.ccr.20210503.15

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    ACS Style

    Jie Chen; Wenjie Liang; Mei Wei; Mingqi Zheng; Gang Liu, et al. Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature. Cardiol. Cardiovasc. Res. 2021, 5(3), 153-156. doi: 10.11648/j.ccr.20210503.15

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    AMA Style

    Jie Chen, Wenjie Liang, Mei Wei, Mingqi Zheng, Gang Liu, et al. Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature. Cardiol Cardiovasc Res. 2021;5(3):153-156. doi: 10.11648/j.ccr.20210503.15

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  • @article{10.11648/j.ccr.20210503.15,
      author = {Jie Chen and Wenjie Liang and Mei Wei and Mingqi Zheng and Gang Liu and Guoping Ma},
      title = {Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature},
      journal = {Cardiology and Cardiovascular Research},
      volume = {5},
      number = {3},
      pages = {153-156},
      doi = {10.11648/j.ccr.20210503.15},
      url = {https://doi.org/10.11648/j.ccr.20210503.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210503.15},
      abstract = {Background: About 5-10% of all myocardial infarction patients undergoing diagnostic coronary angiography for typical chest pain have no significant coronary stenosis (stenosis severity Objective: To report a case of MINOCA, analyze its clinical manifestations, imaging and related treatment, and improve the understanding of clinicians on MINOCA. Methods: A case of MINOCA diagnosed in the First Hospital of Hebei Medical University on June 8, 2021 was retrospectively analyzed. Clinical data related to clinical manifestations, examination results, diagnosis and treatment process were collected, and literatures related to non-obstructive myocardial infarction were reviewed to summarize its diagnosis and treatment characteristics. Results: The patient was a 73-year-old male, who was admitted to hospital for 8 hours due to sudden precardiac pain. After admission, relevant preoperative examination was completed, and preoperative electrocardiogram (ECG) and troponin examination results were considered as acute inferior wall myocardial infarction, percutaneous coronary angiography showed no significant narrowing of the coronary vessels and was diagnosed as MINOCA. The patient regularly applied drugs outside the hospital and was generally in good condition. He did not go to the hospital again. Conclusion: 1. MINOCA accounts for 5-10% of all MI patients, and a higher proportion of MINOCA patients are female. 2. It was previously believed that MINOCA patients had a good prognosis, but the incidence of major adverse cardiovascular events was still high in clinical work. The pathogenesis of MINOCA is complex and diverse, and early drug intervention and secondary prevention targeting the etiology can improve the prognosis of patients. 3. The clinical manifestations and characteristics of MINOCA patients were summarized in this case, the possible pathogenesis and treatment, so as to improve the understanding of this disease, screen high-risk groups for early intervention, and reduce the risk of adverse cardiovascular events in these patients.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature
    AU  - Jie Chen
    AU  - Wenjie Liang
    AU  - Mei Wei
    AU  - Mingqi Zheng
    AU  - Gang Liu
    AU  - Guoping Ma
    Y1  - 2021/09/15
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ccr.20210503.15
    DO  - 10.11648/j.ccr.20210503.15
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
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    EP  - 156
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20210503.15
    AB  - Background: About 5-10% of all myocardial infarction patients undergoing diagnostic coronary angiography for typical chest pain have no significant coronary stenosis (stenosis severity Objective: To report a case of MINOCA, analyze its clinical manifestations, imaging and related treatment, and improve the understanding of clinicians on MINOCA. Methods: A case of MINOCA diagnosed in the First Hospital of Hebei Medical University on June 8, 2021 was retrospectively analyzed. Clinical data related to clinical manifestations, examination results, diagnosis and treatment process were collected, and literatures related to non-obstructive myocardial infarction were reviewed to summarize its diagnosis and treatment characteristics. Results: The patient was a 73-year-old male, who was admitted to hospital for 8 hours due to sudden precardiac pain. After admission, relevant preoperative examination was completed, and preoperative electrocardiogram (ECG) and troponin examination results were considered as acute inferior wall myocardial infarction, percutaneous coronary angiography showed no significant narrowing of the coronary vessels and was diagnosed as MINOCA. The patient regularly applied drugs outside the hospital and was generally in good condition. He did not go to the hospital again. Conclusion: 1. MINOCA accounts for 5-10% of all MI patients, and a higher proportion of MINOCA patients are female. 2. It was previously believed that MINOCA patients had a good prognosis, but the incidence of major adverse cardiovascular events was still high in clinical work. The pathogenesis of MINOCA is complex and diverse, and early drug intervention and secondary prevention targeting the etiology can improve the prognosis of patients. 3. The clinical manifestations and characteristics of MINOCA patients were summarized in this case, the possible pathogenesis and treatment, so as to improve the understanding of this disease, screen high-risk groups for early intervention, and reduce the risk of adverse cardiovascular events in these patients.
    VL  - 5
    IS  - 3
    ER  - 

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Author Information
  • Graduate School of Hebei Medical University, Hebei Medical University, Shijiazhuang, China

  • College of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China

  • The First Hospital of Hebei Medical University, Shijiazhuang, China

  • The First Hospital of Hebei Medical University, Shijiazhuang, China

  • The First Hospital of Hebei Medical University, Shijiazhuang, China

  • The First Hospital of Hebei Medical University, Shijiazhuang, China

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