MINOCA: current perspectives

Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a syndrome with different causes, characterized by clinical evidence of MI with normal or near-normal coronary arteries on angiography (stenosis <50%) [1, 2]. Recent data in a contemporary cohort of patients with MI reported a prevalence around 10% of cases which appears to reflect daily clinical practice [3]. However, the prognosis of patients presenting with MINOCA is not as benign as reported by early cohort studies and as commonly assumed by physicians. Indeed, recent retrospective analysis of patients enrolled in the ACUITY trial showed that, compared with non-ST elevation MI patients and obstructive coronary arteries, patients with MINOCA had a higher adjusted risk of mortality at 1 year (5.2 vs. 1.6%; HR 3.44, CI 1.05– 11.28) [3]. MINOCA patients represent a conundrum given the many possible aetiologies and pathogenic mechanisms associated with this syndrome [1]. For this reason, the key principle in the management of this syndrome is to clarify the underlying individual mechanisms in order to achieve patient-specific treatments. Of importance, meEditorial