S.D. MAYANSKAYA¹, A.A. GILMANOV², M.M. MANGUSHEVA¹, G.I. ALIAKBEROVA², E.I. SAFINA², A.F. USMANOVA¹, G.A. ALEKSEYEV¹, E.R. NURMIYEVA¹

 ¹Kazan State Medical University, Kazan

²Republican Clinical Hospital, Kazan

 Contact details:

Mayanskaya S.D. — MD, Professor of the Department of Hospital Therapy

Address: 49 Butlerov St., Kazan. Russian Federation, 420012, tel.: +7-905-316-99-66, e-mail: Smayanskaya@mail.ru

 The article discusses the problem of myocardial infarction with non-obstructve coronary arteries (MINOCA) based on the proposed diagnostic criteria for this disease. Referring to the fourth definition of myocardial infarction by the European Society of Cardiology, the present classification of infarction without coronary obstruction is presented. The problem of this disease consists, first of all, in a wide variety of causes and pathophysiological mechanisms that contribute to the development of MINOCA. The complexity of this topic also lies in the fact that the absence of obstruction according to coronary angiography does not mean that it does not exist. This may be based on a spasm of the coronary vessels or intermuscular «bridges», or microvascular dysfunction, or dissection of the coronary vessels, or other conditions. Verification of these conditions requires a more in-depth approach to diagnosis and the use of a number of expensive methods, such as magnetic resonance imaging of the myocardium with intravenous contrast, multispiral computed tomography of the coronary arteries, as well as, if possible, specific provocative tests. As an illustration of the MINOCA problem, two clinical cases of myocardial infarction without obstruction of the coronary arteries are presented. The first is myocardial infarction with ST segment elevation and with the Q wave, and the second — without the ST segment elevation.

Conclusion. Further research is needed to develop targeted therapeutic interventions to improve the diagnosis and prognosis of patients with MINOCA.

Key words: MINOCA, non-obstructive coronary artery diseases, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, diagnosis, prognosis. 

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