冠状动脉非阻塞性心肌梗死的研究进展

Research progress of myocardial infarction with non obstructive coronary arteries

随着冠状动脉造影(CAG)的普及和心肌损伤标志物检测水平的提高,冠状动脉非阻塞性心肌梗死(MINOCA)的报道日渐增多,近年来其概念不断更新,2020年欧洲指南正式将MINOCA确立为一种“工作诊断”以促进临床医师进一步寻找心肌损伤的原因。但由于受经济、经验、技术水平等多方面的限制,临床实际工作对MINOCA病因尚未完全明确,本文结合国内外最新研究结果对MINOCA的病因及治疗进展进行分类总结阐述,并提供不同医疗资源条件下的两种不同诊断思路,建议结合临床实际情况制订MINOCA的诊断策略,以期及时准确地诊断,改善患者预后,同时节约医疗资源。

With the popularization of coronary angiography and the improvement of myocardial injury markers,the reports of myocardial infarc-tion with non-obstructive coronary arteries(MINOCA)are increasing,in recent years,its concept has been constantly updated,in 2020,the European guidelines formally established MINOCA as a"working diagnosis"to promote physicians to further explore the causes of myocardial injury.Howev-er,due to the limitations of economy,experience,technical level and other aspects,the etiology of MINOCA is not yet fully understand in clinical practice.Based on the latest research on MINOCA in China and abroad,this review summarizes the progress in MINOCA etiology and treatment,two different diagnostic methods under different medical resources are provided,it is suggested that the diagnosis strategy of MINOCA should be com-bined with the actual clinical situation in order to improve the prognosis of patients and save medical resources through timely and accurate diagnosis.