Table 2.
Diagnostic criteria and causes of myocardial infarction with non-obstructive coronary arteries
| Diagnostic criteria and causes for myocardial infarction with non-obstructive coronary arteries according to the ESC working group position paper[3] |
| Diagnostic criteria: |
| The diagnosis of MINOCA is made immediately upon coronary angiography in a patient presenting with features consistent with an acute myocardial infarction, as detailed by the following criteria: |
| (1) AMI criteria |
| (a) Positive cardiac biomarker (preferably cardiac troponin) defined as a rise and/or fall in serial levels, with at least one value above the 99th percentile upper reference limit |
| (b) Corroborative clinical evidence of infarction evidenced by at least one of the following: |
| Symptoms of ischaemia |
| New or presumed new significant ST-T changes or new LBBB |
| Development of pathological Q waves |
| Imaging evidence of new loss of viable myocardium or new RWMA |
| Intracoronary thrombus evident on angiography or at autopsy |
| (2) Non-obstructive coronary arteries on angiography: |
| Defined as the absence of obstructive CAD on angiography, (i.e. no coronary artery stenosis ≥ 50%), in any potential infarct-related artery. This includes both patients with: |
| This includes both patients with: |
| Normal coronary arteries (no stenosis < 30%) |
| Mild coronary atheromatosis (stenosis > 30% but < 50%). |
| No clinically overt specific cause for the acute presentation: |
| At the time of angiography, the cause and thus a specific diagnosis for the clinical presentation is not apparent |
| Accordingly, there is a necessity to further evaluate the patient for the underlying cause of the MINOCA presentation |
| Causes |
| Plaque rupture or erosion |
| Coronary artery spasm |
| Thromboembolism |
| Coronary dissection |
| Takotsubo syndrome |
| Unrecognized myocarditis, and |
| Other forms of type-2 myocardial infarction |
CAD: Coronary artery disease; ESC: European society of cardiology; MINOCA: Non-obstructive coronary arteries; RWMA: Regional wall motion abnormality; LBBB: Left bundle branch block; AMI: Acute myocardial infarction.