open access

Vol 25, No 3 (2021)
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 Buller1, Szymon Rosiak2, Wojciech Rosiak3, Maciej Tyczyński4, Robert J. Gil45, Jacek Bil5
·
Arterial Hypertension 2021;25(3):106-111.
Affiliations
  1. Department of Cardiology, Voivodeship Hospital, Płock, Poland
  2. Medical University of Gdańsk, Gdańsk, Gdańsk, Poland
  3. Internal Medicine Ward, District Hospital, Żuromin, Poland
  4. Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
  5. Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland

open access

Vol 25, No 3 (2021)
REVIEW
Published online: 2021-05-18

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 and it 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 among 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

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 and it 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 among 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.

Get Citation

Keywords

MINOCA; 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

Vol 25, No 3 (2021)

Article type

Review paper

Pages

106-111

Published online

2021-05-18

Page views

11642

Article views/downloads

549

DOI

10.5603/AH.a2021.0009

Bibliographic record

Arterial Hypertension 2021;25(3):106-111.

Keywords

MINOCA
acetylcholine
hypertensive heart disease
coronary artery remodeling

Authors

Patryk Buller
Szymon Rosiak
Wojciech Rosiak
Maciej Tyczyński
Robert J. Gil
Jacek Bil

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