Advances in Mechanisms and Treatment Options of MINOCA Caused by Vasospasm or Microcirculation Dysfunction

Myocardial Infarction (MI) with Non-obstructive Coronary Arteries (MINOCA) is a syndrome with underlying many causes. MINOCA incidence is estimated to be between 5% and 25% of all MI. The outcome is extremely variable depending on the MINOCA cause. Clinical history, laboratory tests, echocardiography and coronary angiography are the first line diagnostic investigations. Nevertheless, further tests are frequently necessary (e.g. optical coherence tomography, invasive provocative test with acetylcholine or cardiac magnetic resonance) to establish the exact cause, and allowing the adequate risk stratification and management. This is crucial since many patients, particularly those with angiographically normal coronary arteries, are often labelled as ‘noncardiac’, therefore missing the chance for appropriate treatment. And this group of patients characterizes substantially worse outcome than previously it was believed. Here, we have reviewed the pathogenesis, diagnosis, prognosis, and management of MINOCA caused by coronary vasospasm or coronary microcirculation dysfunction.