Ischemia and myocardial infarction without obstructive coronary artery disease

Summary

Myocardial ischemia may be caused not only by flow-limiting obstructions in the epicardial vessels, but also by a variety of non-obstructive mechanisms leading to a mismatch between myocardial oxygen demand and blood flow supply. This explains why a large proportion (up to 70%) of patients undergoing coronary angiography because of angina and demonstrated myocardial ischaemia do not have coronary artery disease with obstructive lesions.11. Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, Prescott E, Karam N, Appelman Y, Fraccaro C, Louise Buchanan G, Manzo-Silberman S, Al-Lamee R, Regar E, Lansky A, Abbott JD, Badimon L, Duncker DJ, Mehran R, Capodanno D, Baumbach A. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020 ;41:3504-3520. Link Furthermore, myocardial infarction (MI) in the absence of obstructive coronary artery disease (MINOCA) can be found in ≈5% to 6% of all patients with acute infarction who are referred for coronary angiography.22. Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, Lerman A, Cushman M,...