CONTEMPORARY APPROACHES TO MYOCARDIAL INFARCTION WITHOUT CORONARY ARTERY STENOSIS
Abstract
Non–ST-segment elevation myocardial infarction (NSTEMI) is one of the most common forms of acute coronary syndromes and represents a leading cause of cardiovascular morbidity and mortality. In recent years, a substantial proportion of patients presenting with a clinical picture of NSTEMI have been found to have no significant coronary artery stenosis on coronary angiography; this condition is currently defined as myocardial infarction with non-obstructive coronary arteries (MINOCA). This review aims to highlight the pathogenetic mechanisms, diagnostic approaches, risk stratification, and principles of personalized management of myocardial infarction without obstructive coronary artery disease. Diagnostic and therapeutic strategies for MINOCA were analyzed based on international clinical guidelines, large registries, and systematic reviews. MINOCA is a heterogeneous syndrome encompassing multiple pathogenic mechanisms, and treatment tailored to the underlying etiology identified through contemporary imaging modalities significantly improves clinical outcomes. Comprehensive diagnostic evaluation and mechanism-oriented, personalized therapy represent the optimal clinical strategy for patients with NSTEMI presenting as MINOCA.
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