General Approach to Acute Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Systematic Review

Abstract Background Acute myocardial infarction (AMI) without obstructive coronary arteries (MINOCA) is a medical condition of great relevance, with clinical characteristics of AMI, but without evidence of coronary artery obstruction. The mechanism involved in the pathophysiology of the disease and its possible etiologies are important objects of study due to their impact on the morbidity and mortality of affected patients. Objectives The aim of this study was to systematically review MINOCA and its characteristics, with emphasis on the clinical profile of patients, etiology, pathophysiology, diagnosis, and treatment of the syndrome. Methods Relevant articles related to MINOCA were analyzed in the PubMed and LILACS databases. In the initial search stage, 619 eligible articles were obtained, with final inclusion criteria being: original systematic reviews with clinical, epidemiological, diagnostic, or treatment data on MINOCA, published in Portuguese or English, with an abstract, and a publication date limit of September 2020. Results A total of 10 articles classified as systematic reviews that considered clinical data on MINOCA were included in this review. Conclusion After analyzing various literature, the present study provided a tool to better understand MINOCA, not only regarding its casuistry but also in grouping parameters and information that contribute to a healthy approach to this clinical situation. It was possible to identify and better outline the clinical profile of patients who presented this condition and the use of appropriate tools for correct diagnosis and ideal treatment.背景：无阻塞性冠状动脉的急性心肌梗死（Acute Myocardial Infarction without Obstructive Coronary Arteries, MINOCA）是一类具有重要临床价值的疾病，患者表现出急性心肌梗死的临床特征，但无冠状动脉阻塞的证据。鉴于该疾病对受累患者的发病率与死亡率存在显著影响，其病理生理学机制及潜在病因均为当前重要的研究方向。目的：本研究旨在对MINOCA及其临床特征开展系统综述，重点聚焦该综合征的患者临床表型、病因、病理生理学、诊断及治疗方案。方法：本研究对PubMed数据库与拉丁美洲和加勒比健康科学文献数据库（LILACS）中与MINOCA相关的文献进行了梳理分析。初始检索阶段共获取619篇符合初步条件的文献，最终纳入标准如下：涉及MINOCA临床、流行病学、诊断或治疗数据的原创性系统综述，以葡萄牙语或英语发表并附有摘要，且发表时间不晚于2020年9月。结果：本综述最终纳入10篇包含MINOCA临床数据的系统综述类文献。结论：通过对各类相关文献的分析，本研究为全面深入认识MINOCA提供了有力支撑，不仅涵盖了该疾病的病例构成特征，还整合了可为该临床场景制定规范诊疗方案提供支持的相关参数与信息。本研究明确并进一步完善了该病患者的临床表型，同时证实可通过合适的工具实现精准诊断与优化治疗。