Fisiopatología y algoritmo diagnóstico y terapéutico del MINOCA

Autores/as

  • Juan Pablo Ricarte-Bratti Universidad Nacional de Córdoba
  • Julio Oscar Emilio Bono Sanatorio Allende
  • Raul Barcudi

DOI:

https://doi.org/10.31053/1853.0605.v80.n1.36817

Palabras clave:

MINOCA, infarto de miocardio, síndrome coronario agudo

Resumen

MINOCA es un síndrome que abarca varias patologías y que ocurre en el contexto clínico de un Síndrome Coronario Agudo. Su incidencia varía de acuerdo con la población estudiada, métodos de diagnósticos utilizados y si han incluido a la Miocarditis y Síndrome de Takotsubo, los cuáles, fueron excluidos recientemente de la definición de MINOCA. Por esta razón, consideramos que la novedad de esta publicación es la no inclusión de estas dos patologías y, por lo tanto, el objetivo de la presente revisión es actualizar este síndrome de forma concisa. También se aborda el manejo de los tres tipos de MINOCA, cuyo diagnóstico se basa fundamentalmente en la utilización de imágenes complementarias específicas, ya que la coronariografia tiene sus limitaciones. El tratamiento será en general farmacológico de acuerdo con el mecanismo fisiopatológico involucrado.

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Biografía del autor/a

  • Juan Pablo Ricarte-Bratti, Universidad Nacional de Córdoba

    Médico Cirujano, Doctor en Medicina, Especialista en Cardiología, Farmacología y Medicina Interna, Fellow del Institut de Cardiologie de Montreal (Canadá), Staff Coordinador de la Unidad Coronaria del Sanatorio Allende Nueva Córdoba, Prof. Asociado Cátedra de Farmacología General UNC y UCC, Prof. del Posgrado de Medicina Interna y Cardiología UNC y UCC.

  • Julio Oscar Emilio Bono, Sanatorio Allende

    Médico Cirujano, Especialista en Cardiología y Terapia Intensiva, Jefe de la Unidad Coronaria del Sanatorio Allende Nueva Córdoba, Prof. del Posgrado en Cardiología de la UCC.

  • Raul Barcudi

    Médico Cirujano, Especialista en Cardiología. Cardiologo Universitario staff Clinica Universitaria Reina Fabiola,  Universidad Católica de Córdoba. Docente de pre y posgrado Facultad de Ciencias de la Salud,  Universidad Católica de Córdoba. Presidente del Comité de Cardiopatía Isquémica, Federación Argentina de Cardiología.

Referencias

1. Singh T, Chapman AR, Dweck MR, Mills NL, Newby DE. MINOCA: a heterogenous group of conditions associated with myocardial damage. Heart. 2021 Sep;107(18):1458-1464. doi: 10.1136/heartjnl-2020-318269.

2. 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 Mar 10;131(10):861-70. doi: 10.1161/CIRCULATIONAHA.114.011201.

3. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P; WG on Cardiovascular Pharmacotherapy. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017 Jan 14;38(3):143-153. doi: 10.1093/eurheartj/ehw149.

4. Barr PR, Harrison W, Smyth D, Flynn C, Lee M, Kerr AJ. Myocardial Infarction Without Obstructive Coronary Artery Disease is Not a Benign Condition (ANZACS-QI 10). Heart Lung Circ. 2018 Feb;27(2):165-174. doi: 10.1016/j.hlc.2017.02.023.

5. Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, Chaitman B, Williams DO, Braunwald E. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol. 1994 Sep 15;74(6):531-7. doi: 10.1016/0002-9149(94)90739-0.

6. Larsen AI, Nilsen DW, Yu J, Mehran R, Nikolsky E, Lansky AJ, Caixeta A, Parise H, Fahy M, Cristea E, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Stone GW. Long-term prognosis of patients presenting with ST-segment elevation myocardial infarction with no significant coronary artery disease (from the HORIZONS-AMI trial). Am J Cardiol. 2013 Mar 1;111(5):643-8. doi: 10.1016/j.amjcard.2012.11.011.

7. Patel MR, Chen AY, Peterson ED, Newby LK, Pollack CV Jr, Brindis RG, Gibson CM, Kleiman NS, Saucedo JF, Bhatt DL, Gibler WB, Ohman EM, Harrington RA, Roe MT. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J. 2006 Oct;152(4):641-7. doi: 10.1016/j.ahj.2006.02.035.

8. Roe MT, Harrington RA, Prosper DM, Pieper KS, Bhatt DL, Lincoff AM, Simoons ML, Akkerhuis M, Ohman EM, Kitt MM, Vahanian A, Ruzyllo W, Karsch K, Califf RM, Topol EJ. Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators. Circulation. 2000 Sep 5;102(10):1101-6. doi: 10.1161/01.cir.102.10.1101.

9. Smilowitz NR, Mahajan AM, Roe MT, Hellkamp AS, Chiswell K, Gulati M, Reynolds HR. Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Circ Cardiovasc Qual Outcomes. 2017 Dec;10(12):e003443. doi: 10.1161/CIRCOUTCOMES.116.003443.

10. Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc. 2018 Jun 28;7(13):e009174. doi: 10.1161/JAHA.118.009174.

11. Pustjens TFS, Appelman Y, Damman P, Ten Berg JM, Jukema JW, de Winter RJ, Agema WRP, van der Wielen MLJ, Arslan F, Rasoul S, van 't Hof AWJ. Guidelines for the management of myocardial infarction/injury with non-obstructive coronary arteries (MINOCA): a position paper from the Dutch ACS working group. Neth Heart J. 2020 Mar;28(3):116-130. doi: 10.1007/s12471-019-01344-6. Erratum in: Neth Heart J. 2020 Jan;28(1):59.

12. Dastidar AG, Baritussio A, De Garate E, Drobni Z, Biglino G, Singhal P, Milano EG, Angelini GD, Dorman S, Strange J, Johnson T, Bucciarelli-Ducci C. Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries. JACC Cardiovasc Imaging. 2019 Oct;12(10):1973-1982. doi: 10.1016/j.jcmg.2018.12.023.

13. Yin G, Abdu FA, Liu L, Xu S, Xu B, Luo Y, Lv X, Fan R, Che W. Prognostic Value of GRACE Risk Scores in Patients With Non-ST-Elevation Myocardial Infarction With Non-obstructive Coronary Arteries. Front Cardiovasc Med. 2021 Feb 16;8:582246. doi: 10.3389/fcvm.2021.582246.

14. Pelliccia F, Pasceri V, Niccoli G, Tanzilli G, Speciale G, Gaudio C, Crea F, Camici PG. Predictors of Mortality in Myocardial Infarction and Nonobstructed Coronary Arteries: A Systematic Review and Meta-Regression. Am J Med. 2020 Jan;133(1):73-83.e4. doi: 10.1016/j.amjmed.2019.05.048.

15. Pasupathy S, Lindahl B, Litwin P, Tavella R, Williams MJA, Air T, Zeitz C, Smilowitz NR, Reynolds HR, Eggers KM, Nordenskjöld AM, Barr P, Jernberg T, Marfella R, Bainey K, Sodoon Alzuhairi K, Johnston N, Kerr A, Beltrame JF. Survival in Patients With Suspected Myocardial Infarction With Nonobstructive Coronary Arteries: A Comprehensive Systematic Review and Meta-Analysis From the MINOCA Global Collaboration. Circ Cardiovasc Qual Outcomes. 2021 Nov;14(11):e007880. doi: 10.1161/CIRCOUTCOMES.121.007880.

16. Ciliberti G, Compagnucci P, Urbinati A, Bianco F, Stronati G, Lattanzi S, Dello Russo A, Guerra F. Myocardial Infarction Without Obstructive Coronary Artery Disease (MINOCA): A Practical Guide for Clinicians. Curr Probl Cardiol. 2021 Mar;46(3):100761. doi: 10.1016/j.cpcardiol.2020.100761..

17. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014 Jun 6;114(12):1852-66. doi: 10.1161/CIRCRESAHA.114.302721.

18. Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol. 2013 Nov 5;62(19):1748-58. doi: 10.1016/j.jacc.2013.05.071.

19. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013). Circ J. 2014;78(11):2779-801. doi: 10.1253/circj.cj-66-0098.

20. Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Cammà G, Lanza GA, Crea F. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. Eur Heart J. 2018 Jan 7;39(2):91-98. doi: 10.1093/eurheartj/ehx667.

21. Ciliberti G, Seshasai SRK, Ambrosio G, Kaski JC. Safety of intracoronary provocative testing for the diagnosis of coronary artery spasm. Int J Cardiol. 2017 Oct 1;244:77-83. doi: 10.1016/j.ijcard.2017.05.109..

22. Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, Iwaguro T, Ueno S, Okumoto Y, Akasaka T. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016 Jun;5(3):263-70. doi: 10.1177/2048872613504310.

23. Rashid HN, Wong DT, Wijesekera H, Gutman SJ, Shanmugam VB, Gulati R, Malaipan Y, Meredith IT, Psaltis PJ. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome--A single-centre Australian experience. Int J Cardiol. 2016 Jan 1;202:336-8. doi: 10.1016/j.ijcard.2015.09.072.

24. Adlam D, Alfonso F, Maas A, Vrints C; Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018 Sep 21;39(36):3353-3368. doi: 10.1093/eurheartj/ehy080.

25. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018 Oct 30;72(18):2231-2264. doi: 10.1016/j.jacc.2018.08.1038.

26. Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjöld A, Gard A, Jernberg T. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Circulation. 2017 Apr 18;135(16):1481-1489. doi: 10.1161/CIRCULATIONAHA.116.026336.

27. Mannucci PM, Asselta R, Duga S, Guella I, Spreafico M, Lotta L, Merlini PA, Peyvandi F, Kathiresan S, Ardissino D. The association of factor V Leiden with myocardial infarction is replicated in 1880 patients with premature disease. J Thromb Haemost. 2010 Oct;8(10):2116-21. doi: 10.1111/j.1538-7836.2010.03982.x.

28. Tomaiuolo R, Bellia C, Caruso A, Di Fiore R, Quaranta S, Noto D, Cefalù AB, Di Micco P, Zarrilli F, Castaldo G, Averna MR, Ciaccio M. Prothrombotic gene variants as risk factors of acute myocardial infarction in young women. J Transl Med. 2012 Nov 21;10:235. doi: 10.1186/1479-5876-10-235.

29. Sucato V, Testa G, Puglisi S, Evola S, Galassi AR, Novo G. Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management. J Cardiol. 2021 May;77(5):444-451. doi: 10.1016/j.jjcc.2021.01.001..

30. Scalone G, Niccoli G, Crea F. Editor's Choice- Pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care. 2019 Feb;8(1):54-62. doi: 10.1177/2048872618782414.

31. Ahmadi N, Nabavi V, Hajsadeghi F, Flores F, French WJ, Mao SS, Shavelle D, Ebrahimi R, Budoff M. Mortality incidence of patients with non-obstructive coronary artery disease diagnosed by computed tomography angiography. Am J Cardiol. 2011 Jan;107(1):10-6. doi: 10.1016/j.amjcard.2010.08.034.

32. Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, Lerman A, Cushman M, Kumbhani DJ, Arslanian-Engoren C, Bolger AF, Beltrame JF; American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; and Council on Quality of Care and Outcomes Research. 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 Apr 30;139(18):e891-e908. doi: 10.1161/CIR.0000000000000670.

33. Vancheri F, Longo G, Vancheri S, Henein M. Coronary Microvascular Dysfunction. J Clin Med. 2020 Sep 6;9(9):2880. doi: 10.3390/jcm9092880.

34. Cohen Arazi H, Iglesias R, Duronto E, Lescano A, Campisi R, Deviggiano A, Caroli C, Nani S, Mariani J, Comtesse D, Zanotti S, Kaski JC; GREECO (Grupo de Estudio de Enfermedades Coronarias). Isquemia miocárdica sin lesiones coronarias obstructivas: MINOCA-INOCA. Revisión para la toma de decisiones [Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making]. Medicina (B Aires). 2020;80(3):253-270. Spanish.

35. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007 Feb 22;356(8):830-40. doi: 10.1056/NEJMra061889.

36. Sandoval Y, Jaffe AS. Type 2 Myocardial Infarction: JACC Review Topic of the Week. J Am Coll Cardiol. 2019 Apr 16;73(14):1846-1860. doi: 10.1016/j.jacc.2019.02.018.

37. Kosmas N, Manolis AS, Dagres N, Iliodromitis EK. Myocardial infarction or acute coronary syndrome with non-obstructive coronary arteries and sudden cardiac death: a missing connection. Europace. 2020 Sep 1;22(9):1303-1310. doi: 10.1093/europace/euaa156.

38. Ciliberti G, Finocchiaro G, Papadakis M, Westaby JD, Sharma S, Sheppard MN. Myocardial Infarction With Nonobstructed Coronary Arteries and Sudden Cardiac Death: A Clinical and Pathological Perspective. Circ Arrhythm Electrophysiol. 2020 Jul;13(7):e008302. doi: 10.1161/CIRCEP.119.008302.

39. Talebi S, Moreno P, Dominguez AC, Tamis-Holland JE. The Imaging Toolbox to Assess Patients with Suspected Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA). Curr Cardiol Rep. 2020 Sep 10;22(11):134. doi: 10.1007/s11886-020-01379-x.

40. Smits PC, Abdel-Wahab M, Neumann FJ, Boxma-de Klerk BM, Lunde K, Schotborgh CE, Piroth Z, Horak D, Wlodarczak A, Ong PJ, Hambrecht R, Angerås O, Richardt G, Omerovic E; Compare-Acute Investigators. Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction. N Engl J Med. 2017 Mar 30;376(13):1234-1244. doi: 10.1056/NEJMoa1701067.

41. Opolski MP, Spiewak M, Marczak M, Debski A, Knaapen P, Schumacher SP, Staruch AD, Grodecki K, Chmielak Z, Lazarczyk H, Kukula K, Tyczynski P, Pregowski J, Dabrowski M, Kadziela J, Florczak E, Skrobisz A, Witkowski A. Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease: Results From the Optical Coherence Tomography Study. JACC Cardiovasc Imaging. 2019 Nov;12(11 Pt 1):2210-2221. doi: 10.1016/j.jcmg.2018.08.022.

42. Ouldzein H, Elbaz M, Roncalli J, Cagnac R, Carrié D, Puel J, Alibelli-Chemarin MJ. Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: analysis by intravascular ultrasound. Ann Cardiol Angeiol (Paris). 2012 Feb;61(1):20-6. doi: 10.1016/j.ancard.2011.07.011.

43. Oikonomou EK, West HW, Antoniades C. Cardiac Computed Tomography: Assessment of Coronary Inflammation and Other Plaque Features. Arterioscler Thromb Vasc Biol. 2019 Nov;39(11):2207-2219. doi: 10.1161/ATVBAHA.119.312899.

44. Kitagawa T, Yamamoto H, Horiguchi J, Ohhashi N, Tadehara F, Shokawa T, Dohi Y, Kunita E, Utsunomiya H, Kohno N, Kihara Y. Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging. 2009 Feb;2(2):153-60. doi: 10.1016/j.jcmg.2008.09.015.

45. Mohri M, Takeshita A. Coronary microvascular disease in humans. Jpn Heart J. 1999 Mar;40(2):97-108. doi: 10.1536/jhj.40.97.

46. Sueda S, Kohno H, Ochi T, Uraoka T, Tsunemitsu K. Overview of the pharmacological spasm provocation test: Comparisons between acetylcholine and ergonovine. J Cardiol. 2017 Jan;69(1):57-65. doi: 10.1016/j.jjcc.2016.09.012.

47. Pasupathy S, Beltrame JF. Refining the Role of CMR Imaging in MINOCA. JACC Cardiovasc Imaging. 2021 Sep;14(9):1784-1786. doi: 10.1016/j.jcmg.2021.03.024.

48. Reynolds HR, Srichai MB, Iqbal SN, Slater JN, Mancini GB, Feit F, Pena-Sing I, Axel L, Attubato MJ, Yatskar L, Kalhorn RT, Wood DA, Lobach IV, Hochman JS. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011 Sep 27;124(13):1414-25. doi: 10.1161/CIRCULATIONAHA.111.026542.

49. Choo EH, Chang K, Lee KY, Lee D, Kim JG, Ahn Y, Kim YJ, Chae SC, Cho MC, Kim CJ, Kim HS, Jeong MH; KAMIR‐NIH Investigators. Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non-Obstructive Coronary Arteries. J Am Heart Assoc. 2019 Jul 16;8(14):e011990. doi: 10.1161/JAHA.119.011990.

50. Bossard M, Gao P, Boden W, Steg G, Tanguay JF, Joyner C, Granger CB, Kastrati A, Faxon D, Budaj A, Pais P, Di Pasquale G, Valentin V, Flather M, Moccetti T, Yusuf S, Mehta SR. Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease. Heart. 2021 Nov;107(21):1739-1747. doi: 10.1136/heartjnl-2020-318045.

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2023-03-31

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1.
Ricarte-Bratti JP, Bono JOE, Barcudi R. Fisiopatología y algoritmo diagnóstico y terapéutico del MINOCA. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2023 Mar. 31 [cited 2024 Nov. 20];80(1):36-42. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/36817

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