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Editorial: MINOCA: Pathogenesis, Diagnosis, Clinical Management and Evolution Towards Precision Medicine

Myocardial infarction with non-obstructive coronary disease (MINOCA) represents a heterogeneous clinical conundrum, accounting for approximately 6% of all presentations of acute myocardial infarction (AMI). The diagnosis of MINOCA is often challenging in clinical practice ; however, traditional criteria for AMI, as defined by the fourth universal definition of myocardial infarction (UDMI), outline that it is accompanied by no stenosis ≥50% in a major coronary artery on coronary angiography. The pathophysiological mechanisms in MINOCA are still poorly elucidated and may originate from the processes occurring in the epicardial coronary vessel, in the form of rupture or a fissure of small atherosclerotic plaques, spontaneous coronary artery dissection (SCAD), coronary vasospasm, or in situ thrombosis. Furthermore, coronary microvascular disease (CMD) and increased oxygen demand-to-supply ratio, i.e., type 2 AMI without significant CAD on angiography might be the underlying mechanisms behind MINOCA. Compared to patients with obstructive coronary artery disease (CAD) AMI, patients with MINOCA are slightly younger, more commonly women, and generally have fewer traditional cardiovascular disease (CVD) risk factors or positive history of CVD. From a prognostic standpoint, it was initially thought that MINOCA is a benign condition associated with a favorable prognosis, although recent data clearly show that MINOCA is associated with a significant risk of long-term mortality, reinfarction, and major adverse cardiovascular events (MACE). To better understand the mechanisms behind MINOCA, improve clinical outcomes, and reduce healthcare-related costs, it is necessary to foster research efforts with the potential to unravel the specific causes of MINOCA, meaning therapeutic management can be specifically tailored toward the underlying culprit mechanism. For these reasons, this Research Topic on MINOCA aggregated relevant original and review articles that explore this pathophysiological entity from the perspective of diagnosis, prognosis, and treatment.

MINOCA ; myocardial infarction without obstructive coronary disease ; percutaneous coronary intervention ; risk factors ; imaging ; antiplatelet therapy (AT) ; cardiac magnetic resonance (CMR) imaging ; invasive functional testing ; FFR ; iFR

Invited Editorial on Research Topic entitled "MINOCA: Pathogenesis, Diagnosis, Clinical Management and Evolution Towards Precision Medicine"