The Clinical Spectrum of Myocardial Infarction and Ischemia With Nonobstructive Coronary Arteries in Women

Inge J van den Hoogen; Umberto Gianni; Malissa J Wood; Viviany R Taqueti; Fay Y Lin; Sharonne N Hayes; Gudrun M Feuchtner; Alexander R van Rosendael; Nanette K Wenger; Janet Wei; C Noel Bairey Merz; Carl J Pepine; Leslee J Shaw; American College of Cardiology’s Cardiovascular Disease in Women Committee

doi:10.1016/j.jcmg.2020.06.044

The Clinical Spectrum of Myocardial Infarction and Ischemia With Nonobstructive Coronary Arteries in Women

JACC Cardiovasc Imaging. 2021 May;14(5):1053-1062. doi: 10.1016/j.jcmg.2020.06.044. Epub 2020 Sep 30.

Authors

Affiliations

¹ Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands, USA.
² Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA.
³ Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Women's Heart Clinic, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
⁷ Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
⁸ Barbara Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁹ Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
¹⁰ Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA. Electronic address: les2035@med.cornell.edu.

Abstract

Women exhibit less burden of anatomic obstructive coronary atherosclerotic disease as compared with men of the same age, but contradictorily show similar or higher cardiovascular mortality rates. The higher prevalence of nonexertional cardiac symptoms and nonobstructive coronary atherosclerotic disease in women may lead to lack of recognition and appropriate management, resulting in undertesting and undertreatment. Leaders in women's health from the American College of Cardiology's Cardiovascular Disease in Women Committee present novel imaging cases that may provoke thought regarding the broad clinical spectrum of myocardial infarction and ischemia with nonobstructive coronary arteries in women. These unique imaging approaches are based on the concept of targeting sex-specific differences in acute and stable ischemic heart disease.

Keywords: INOCA; MINOCA; atherosclerosis; coronary microvascular dysfunction; ischemia and no obstructive coronary arteries; myocardial infarction with nonobstructive coronary arteries; sex; women.

MeSH terms

Coronary Angiography
Coronary Vessels* / diagnostic imaging
Female
Humans
Male
Myocardial Infarction* / diagnostic imaging
Myocardial Infarction* / epidemiology
Predictive Value of Tests
Risk Factors
United States

Grants and funding

K23 HL135438/HL/NHLBI NIH HHS/United States