Myocardial infarction with non-obstructive coronary arteries (MINOCA) includes
coronary embolism, dissection, spasm and microvascular dysfunction, as well as
plaque rupture or erosion (causing 50% stenosis). In the most recent studies,
events that can be classified as MINOCA account for approximately 6–8% of all
diagnoses of acute myocardial infarction (AMI). Clinical suspect may suggest the
need for additional diagnostic procedures beyond the usual coronary angiography,
such as cardiac imaging or provocative tests. Cardiac magnetic resonance (CMR) is
essential for both validating the diagnosis and ruling out other conditions with
a comparable clinical presentation. The prognosis is not as good as previously
believed; rather, it is marked by morbidity and mortality rates comparable to
those of other types of AMI. Identification of the underlying causes of MINOCA is
recommended by current guidelines and consensus documents in order to optimize
treatment, enhance prognosis, and encourage prevention of recurrent myocardial
infarction. In this narrative review, we have outlined the various causes of
MINOCA and their specific therapies in an attempt to identify a personalized
approach to its treatment.