Canadian Cardiovascular Society/Canadian Women's Heart Health Alliance Clinical Practice Update on Myocardial Infarction With No Obstructive Coronary Artery Disease (MINOCA)

Christine Pacheco; Thais Coutinho; Alexandra Bastiany; Rob Beanlands; Kevin E Boczar; Martha Gulati; Shuangbo Liu; Judy Luu; Sharon L Mulvagh; Amelie Paquin; Jacqueline Saw; Tara Sedlak

doi:10.1016/j.cjca.2024.02.032

Canadian Cardiovascular Society/Canadian Women's Heart Health Alliance Clinical Practice Update on Myocardial Infarction With No Obstructive Coronary Artery Disease (MINOCA)

Can J Cardiol. 2024 Jun;40(6):953-968. doi: 10.1016/j.cjca.2024.02.032.

Authors

Christine Pacheco¹, Thais Coutinho², Alexandra Bastiany³, Rob Beanlands⁴, Kevin E Boczar⁵, Martha Gulati⁶, Shuangbo Liu⁷, Judy Luu⁸, Sharon L Mulvagh⁹, Amelie Paquin⁶, Jacqueline Saw¹⁰, Tara Sedlak¹⁰

Affiliations

¹ Department of Medicine, Hôpital Pierre-Boucher, Centre de santé et de services sociaux de la Montérégie-Est, Longueuil, Québec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. Electronic address: [email protected].
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³ Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
⁴ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁵ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁶ Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁰ Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 38852985
DOI: 10.1016/j.cjca.2024.02.032

Abstract

Myocardial infarction with no obstructive coronary artery disease (MINOCA) represents 6%-15% of all acute coronary syndromes, and women are disproportionately represented. MINOCA is an encompassing preliminary diagnosis, and emerging evidence supports a more expansive comprehensive diagnostic and therapeutic clinical approach. The current clinical practice update summarizes the latest evidence regarding the epidemiology, clinical presentation, and diagnostic evaluation of MINOCA. A cascaded approach to diagnostic workup is outlined for clinicians, for noninvasive and invasive diagnostic pathways, depending on clinical setting and local availability of diagnostic modalities. Evidence concerning the nonpharmacological and pharmacological treatment of MINOCA are presented and summarized according to underlying cause of MINOCA, with practical tips on the basis of expert opinion, outlining a real-life, evidence-based, comprehensive approach to management of this challenging condition.

Publication types

Practice Guideline

MeSH terms

Canada / epidemiology
Coronary Artery Disease / diagnosis
Coronary Artery Disease / therapy
Female
Humans
Myocardial Infarction* / diagnosis
Myocardial Infarction* / epidemiology
Myocardial Infarction* / therapy
Societies, Medical
Women's Health*