Table 1.
Main pathophysiology mechanisms known to cause MINOCA/ACS-NNOCA
| Mechanism | Assisting diagnostic modules | Incidence | |
|---|---|---|---|
| 1 | Plaque disruption or eccentric plaque with positive remodelling | Intracoronary imaging (OCT or IVUS) | Up to 40% of MINOCA23,24 |
| 2 | Coronary microvascular spasm or dysfunction | Intracoronary acetylcholine | 25% of ACS-NNOCA25 |
| 3 | Coronary thrombi and emboli | Coronary angiography, identification of an embolic source | 4.3% of STEMI26 |
| 4 | Coronary artery spasm (including substance abuse and smoking) | Intracoronary ergonovine or acetylcholine (not routinely performed) | Up to 27% of MINOCA10 |
| 5 | Spontaneous coronary artery dissection | Intracoronary imaging (OCT or IVUS) | 1.7–4% of ACS27 |
| 6 | Takotsubo cardiomyopathy | LV angiogram, ECHO, CMR | 1.2–2.2% of ACS28 |
| 7 | Myocarditis | Endomyocardial biopsy, CMR | 33% of MINOCA29 |
ACS-NNOCA, acute coronary syndrome with normal or near-normal coronary arteries; CMR, cardiac magnetic resonance; ECHO, echocardiogram; IVUS, intravascular ultrasound; LV, left ventricle; MINOCA, myocardial infarction with non-obstructive coronary arteries; OCT, optical coherence tomography.