Sex-specific and ethnicity-specific differences in MINOCA

Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) has received increasing attention over the past decade. Given the heterogeneity in the mechanisms underlying acute myocardial infarction in the absence of obstructive coronary arteries, the syndrome of MINOCA is considered a working diagnosis that requires further investigation after diagnostic angiography studies have been performed, including coronary magnetic resonance angiography and functional angiography. Although once considered an infrequent and low-risk form of myocardial infarction, recent data have shown that the prognosis of MINOCA is not as benign as previously assumed. However, despite increasing awareness of the condition, many questions remain regarding the diagnosis, risk stratification and treatment of MINOCA. Women seem to be more susceptible to MINOCA, but studies on the sex-specific differences of the disease are scarce. Similarly, ethnicity-specific factors might explain discrepancies in the observed prevalence or underlying pathophysiological mechanisms of MINOCA but data are also scarce. Therefore, in this Review, we provide an update on the latest evidence available on the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA. Myocardial infarction with non-obstructive coronary arteries (MINOCA) has been the focus of an increasing number of studies in the past decade. In this Review, Tavella and colleagues detail the prevalence and clinical presentation of MINOCA, describe the mechanisms underlying the syndrome, and summarize the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA. The overall prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) is estimated to be 6%, and women are over-represented as compared to men.Sex-based differences in adverse events and health outcomes in MINOCA remain largely unreported; however, female patients have an increased risk of major adverse cardiovascular events and worse health status compared with male patients.Spontaneous coronary artery dissection is more common in women, but sex-based differences in genetic and hormonal-related mechanisms of MINOCA require further exploration.The prevalence and clinical characteristics of MINOCA are generally similar across patients from different ethnic backgrounds; however, a higher prevalence of MINOCA has been reported in African-American, Hispanic-American and Pacific Islander populations, whereas Japanese individuals have a greater propensity to coronary artery spasm.Management therapies for MINOCA should be personalized according to the underlying reason for the presentation.