ArticleClinical research in cardiology : official journal of the German Cardiac Society2020
Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA).
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.
- Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2022Pooled it
- Prognosis and risk stratification in first-presentation myocardial infarction with nonobstructive coronary arteries using stress cardiac MRI.Insights into imaging · 2026Article
- Prognostic Impact of Infarct Size and Coronary Microvascular Function Via Cardiovascular Magnetic Resonance and Coronary Angiography-Derived Index of Microcirculatory Resistance in Myocardial Infarction With Nonobstructive Coronary Arteries.Journal of the American Heart Association · 2026Observational
- Non-invasive Coronary Functional Tests in Patients with Angina and Non-obstructive Coronary Artery Disease.European cardiology · 2026Article
- Role of optical coherence tomography in clinical management of myocardial infarction with nonobstructive coronary arteries.Journal of geriatric cardiology : JGC · 2024Article
- Rare Clinical Manifestation of Vasculitis.Diagnostics (Basel, Switzerland) · 2024Article
- MINOCA: A Pathophysiological Approach of Diagnosis and Treatment-A Narrative Review.Biomedicines · 2024Review
- Comparison of Baseline and Post-Nitrate Exercise Testing in Patients with Angina but Non-Obstructed Coronary Arteries with Different Acetylcholine Test Results.Journal of clinical medicine · 2024Article
- A Personalized Approach for Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries.Reviews in cardiovascular medicine · 2024Review
- Reduced stress perfusion in myocardial infarction with nonobstructive coronary arteries.Scientific reports · 2023Article
- Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition).MedComm · 2023Review
- Frequency and Clinical Impact of Family History of Coronary Artery Disease in Patients with Vasospastic Angina.Journal of cardiovascular development and disease · 2023Article
- Intracoronary Diagnostics in Patients with Acute Coronary Syndrome.Reviews in cardiovascular medicine · 2023Review
- Invasive Evaluation for Coronary Vasospasm.US cardiology · 2023Review
- Coronary Microvascular Spasm: Clinical Presentation and Diagnosis.European cardiology · 2023Review
- Mechanisms of Coronary Ischemia in Women.Current cardiology reports · 2022Review
- Ischemic Heart Disease in Young Women: JACC Review Topic of the Week.Journal of the American College of Cardiology · 2022Review
- Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries.Circulation research · 2022Review
- Clinical features and outcomes of patients with stable or unstable chest pain and no-obstructive coronary artery disease.Frontiers in cardiovascular medicine · 2022Article
- Myocardial infarction with non-obstructive coronary artery disease.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
backgroundUp to 30% of patients with acute coronary syndrome have no culprit lesion. Coronary microvascular spasm is an alternative cause for such a clinical presentation. However, this has rarely been investigated systematically. The aim of our study was to assess the frequency of coronary microvascular spasm in patients with NSTEMI without culprit lesion (MINOCA) by intracoronary acetylcholine testing (ACH-test).
methodsBetween 2014 and 2017, 940 patients with NSTEMI underwent coronary angiography and 125 (13%) had no culprit lesion (< 50% stenosis on visual assessment). Of the latter, 29 patients had other causes for the clinical presentation (e.g. tako-tsubo-syndrome or myocarditis). The remaining 96 patients were recruited for the study and underwent ACH-testing according to a standardized protocol.
resultsThe ACH-test was normal in 40 (42%) and abnormal in the remaining 56 (58%) patients. Of the latter, 26 patients (46%) had epicardial spasm (epicardial narrowing ≥ 90%, reproduction of symptoms and ischemic ST-segment changes) and 30 (54%) microvascular spasm (ischemic ST-shifts and angina without epicardial vasoconstriction ≥ 90%). The peak high-sensitive troponin-T concentration was 113 (42-255) pg/ml. Patients with coronary spasm had more often a positive family history compared to those without and patients with epicardial compared to microvascular spasm were more often smokers.
conclusionCoronary microvascular spasm is frequently found in patients with NSTEMI without culprit lesion and represents a likely cause of myocardial injury. ACH-testing is useful for detection of vasomotor disorders allowing tailored treatment with calcium antagonists and/or nitrates in addition to secondary prevention to improve symptoms and prognosis. Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA) .
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