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Foà A, Canton L, Bodega F, Bergamaschi L, Paolisso P, De Vita A, Villano A, Mattioli AV, Tritto I, Morrone D, Lanza GA, Pizzi C. Myocardial infarction with nonobstructive coronary arteries: from pathophysiology to therapeutic strategies. J Cardiovasc Med (Hagerstown) 2023; 24:e134-e146. [PMID: 37186564 DOI: 10.2459/jcm.0000000000001439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by clinical evidence of acute myocardial infarction (AMI) with normal or near-normal coronary arteries on coronary angiography (stenosis < 50%) and without an over the alternative diagnosis for the acute presentation. Its prevalence ranges from 6% to 11% among all patients with AMI, with a predominance of young, nonwhite females with fewer traditional risks than those with an obstructive coronary artery disease (MI-CAD). MINOCA can be due to either epicardial causes such as rupture or fissuring of unstable nonobstructive atherosclerotic plaque, coronary artery spasm, spontaneous coronary dissection and cardioembolism in-situ or microvascular causes. Besides, also type-2 AMI due to supply-demand mismatch and Takotsubo syndrome must be considered as a possible MINOCA cause. Because of the complex etiology and a limited amount of evidence, there is still some confusion around the management and treatment of these patients. Therefore, the key focus of this condition is to identify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, echocardiography, and coronary angiography represent the first-level diagnostic investigations, but coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offer additional information to understand the underlying cause of MINOCA. Although the prognosis is slightly better compared with MI-CAD patients, MINOCA is not always benign and depends on the etiopathology. This review analyzes all possible pathophysiological mechanisms that could lead to MINOCA and provides the most specific and appropriate therapeutic approach in each scenario.
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Affiliation(s)
- Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | | | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia
| | - Doralisa Morrone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCCS Policlinico St. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna
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Foà A, Paolisso P, Bergamaschi L, Rucci P, Di Marco L, Pacini D, Leone O, Galié N, Pizzi C. Clues and pitfalls in the diagnostic approach to cardiac masses: are pseudo-tumours truly benign? Eur J Prev Cardiol 2021; 29:e102-e104. [PMID: 33655300 DOI: 10.1093/eurjpc/zwab032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Alberto Foà
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Luca Bergamaschi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, IRCCS S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, IRCCS S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Ornella Leone
- Cardiovascular and Cardiac Transplant Pathology Unit, Department of Pathology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Nazzareno Galié
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
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