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Review paper
Published online: 2021-05-18
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Arterial hypertension as a risk factor for myocardial infarction with non-obstructive coronary arteries (MINOCA)

Patryk Buller, Szymon Rosiak, Wojciech Rosiak, Maciej Tyczyński, Robert Julian Gil, Jacek Bil
DOI: 10.5603/AH.a2021.0009

open access

Ahead of print
REVIEW
Published online: 2021-05-18

Abstract

ABSTRACT Myocardial infarction with non-obstructive coronary arteries (MINOCA) as a relatively new disease entity distinguished from the group of acute coronary syndromes (ACS) is not a rare clinical problem that requires in-depth diagnostics. MINOCA accounts for 5-10% of all ACS cases. MINOCA is most common between the ages of 50-60 and predominates in females. Coronary microvascular dysfunction and coronary vasospasm are one of the potential mechanisms. The latest guidelines for the treatment of ACS in patients presenting without persistent ST-segment elevation emphasize the importance of searching for the causes of angina in patients with insignificant lesions in the coronary arteries by extending invasive diagnostics (e.g., acetylcholine provocation test) and using noninvasive diagnostics (e.g., CMR or SPECT). In the context of MINOCA, among the typical risk factors for coronary artery disease, arterial hypertension (HTN) seems to be the most important by inducing coronary microcirculation remodeling (mostly hypertrophy) and hence the narrowing of the lumen. Studies comparing patients with MINOCA and obstructive coronary artery disease (MI-CAD) in the context of risk factors, in particular, HTN, were analyzed. In five out of nine analyzed studies, HTN occurred significantly more often in patients with MINOCA compared to patients with MI-CAD. The current pharmacotherapy recommendations focus on slowing the progression of coronary microvascular dysfunction (CMD), i.e., adequate treatment of risk factors and comorbidities, such as HTN. Therefore, it seems reasonable to conduct studies directly analyzing the relationship between HTN and MINOCA in order to improve diagnostics and establish appropriate pharmacotherapy that will improve prognosis.

Abstract

ABSTRACT Myocardial infarction with non-obstructive coronary arteries (MINOCA) as a relatively new disease entity distinguished from the group of acute coronary syndromes (ACS) is not a rare clinical problem that requires in-depth diagnostics. MINOCA accounts for 5-10% of all ACS cases. MINOCA is most common between the ages of 50-60 and predominates in females. Coronary microvascular dysfunction and coronary vasospasm are one of the potential mechanisms. The latest guidelines for the treatment of ACS in patients presenting without persistent ST-segment elevation emphasize the importance of searching for the causes of angina in patients with insignificant lesions in the coronary arteries by extending invasive diagnostics (e.g., acetylcholine provocation test) and using noninvasive diagnostics (e.g., CMR or SPECT). In the context of MINOCA, among the typical risk factors for coronary artery disease, arterial hypertension (HTN) seems to be the most important by inducing coronary microcirculation remodeling (mostly hypertrophy) and hence the narrowing of the lumen. Studies comparing patients with MINOCA and obstructive coronary artery disease (MI-CAD) in the context of risk factors, in particular, HTN, were analyzed. In five out of nine analyzed studies, HTN occurred significantly more often in patients with MINOCA compared to patients with MI-CAD. The current pharmacotherapy recommendations focus on slowing the progression of coronary microvascular dysfunction (CMD), i.e., adequate treatment of risk factors and comorbidities, such as HTN. Therefore, it seems reasonable to conduct studies directly analyzing the relationship between HTN and MINOCA in order to improve diagnostics and establish appropriate pharmacotherapy that will improve prognosis.

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Keywords

INOCA; acetylcholine; hypertensive heart disease; coronary artery remodeling;

About this article
Title

Arterial hypertension as a risk factor for myocardial infarction with non-obstructive coronary arteries (MINOCA)

Journal

Arterial Hypertension

Issue

Ahead of print

Article type

Review paper

Published online

2021-05-18

DOI

10.5603/AH.a2021.0009

Keywords

INOCA
acetylcholine
hypertensive heart disease
coronary artery remodeling

Authors

Patryk Buller
Szymon Rosiak
Wojciech Rosiak
Maciej Tyczyński
Robert Julian Gil
Jacek Bil

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