Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity characterized by myocardial injury in the absence of a significant coronary artery obstruction. MINOCA encompasses a diverse range of pathophysiological mechanisms, including coronary p...

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Main Authors: Chiara Tognola, Alessandro Maloberti, Marisa Varrenti, Patrizio Mazzone, Cristina Giannattasio, Fabrizio Guarracini
Format: Article
Language:English
Published: MDPI AG 2025-04-01
Series:Diagnostics
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Online Access:https://www.mdpi.com/2075-4418/15/7/942
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author Chiara Tognola
Alessandro Maloberti
Marisa Varrenti
Patrizio Mazzone
Cristina Giannattasio
Fabrizio Guarracini
author_facet Chiara Tognola
Alessandro Maloberti
Marisa Varrenti
Patrizio Mazzone
Cristina Giannattasio
Fabrizio Guarracini
author_sort Chiara Tognola
collection DOAJ
description Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity characterized by myocardial injury in the absence of a significant coronary artery obstruction. MINOCA encompasses a diverse range of pathophysiological mechanisms, including coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, thromboembolism, and spontaneous coronary artery dissection. A systematic diagnostic approach is essential to identify the underlying etiology and guide appropriate management strategies. Advanced imaging techniques, particularly cardiac magnetic resonance, play a pivotal role in distinguishing ischemic from non-ischemic myocardial injury and refining prognosis. Despite growing awareness, standardized treatment protocols remain limited, with current management largely extrapolated from strategies used in obstructive coronary artery disease. Notably, MINOCA is significantly more prevalent in women, emphasizing the need to understand sex-related differences in its pathophysiology, presentation, and clinical outcomes. This narrative review offers a comprehensive and up-to-date overview of MINOCA, including a dedicated chapter on sex-related considerations. It integrates recent advancements and highlights the importance of personalized management strategies.
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spelling doaj-art-2f2251bbe45c4a98a67fc4935a5d3ced2025-08-20T02:15:55ZengMDPI AGDiagnostics2075-44182025-04-0115794210.3390/diagnostics15070942Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and ManagementChiara Tognola0Alessandro Maloberti1Marisa Varrenti2Patrizio Mazzone3Cristina Giannattasio4Fabrizio Guarracini5Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyClinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyElectrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyElectrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyClinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyElectrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, ItalyMyocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity characterized by myocardial injury in the absence of a significant coronary artery obstruction. MINOCA encompasses a diverse range of pathophysiological mechanisms, including coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, thromboembolism, and spontaneous coronary artery dissection. A systematic diagnostic approach is essential to identify the underlying etiology and guide appropriate management strategies. Advanced imaging techniques, particularly cardiac magnetic resonance, play a pivotal role in distinguishing ischemic from non-ischemic myocardial injury and refining prognosis. Despite growing awareness, standardized treatment protocols remain limited, with current management largely extrapolated from strategies used in obstructive coronary artery disease. Notably, MINOCA is significantly more prevalent in women, emphasizing the need to understand sex-related differences in its pathophysiology, presentation, and clinical outcomes. This narrative review offers a comprehensive and up-to-date overview of MINOCA, including a dedicated chapter on sex-related considerations. It integrates recent advancements and highlights the importance of personalized management strategies.https://www.mdpi.com/2075-4418/15/7/942MINOCAmyocardial infarctionnonobstructive coronary arteriespathophysiologydiagnosiscardiac magnetic resonance
spellingShingle Chiara Tognola
Alessandro Maloberti
Marisa Varrenti
Patrizio Mazzone
Cristina Giannattasio
Fabrizio Guarracini
Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
Diagnostics
MINOCA
myocardial infarction
nonobstructive coronary arteries
pathophysiology
diagnosis
cardiac magnetic resonance
title Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
title_full Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
title_fullStr Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
title_full_unstemmed Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
title_short Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Insights into Pathophysiology, Diagnosis, and Management
title_sort myocardial infarction with nonobstructive coronary arteries minoca current insights into pathophysiology diagnosis and management
topic MINOCA
myocardial infarction
nonobstructive coronary arteries
pathophysiology
diagnosis
cardiac magnetic resonance
url https://www.mdpi.com/2075-4418/15/7/942
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