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Unraveling MINOCA: The hidden impact of inflammation on myocardial infarction without coronary obstruction Cover

Unraveling MINOCA: The hidden impact of inflammation on myocardial infarction without coronary obstruction

Romanian Journal of Cardiology
Volume 35 (2025): Issue 3 (September 2025)
By: Andra Ioana Stoenescu,  Elena Barbu and  Serban-Mihai Balanescu  
Open Access
|Sep 2025

Figures & Tables

Figure 1

38-year old patient presenting to the E.R. with recent onset chest pain. ECG shows ST elevation in DII, DIII, aVF V5 and V6 (red arrows), suggesting a inferolateral STEMI. Patient undergoes coronary angiogram which reveals normal coronary arteries with no significant stenosis.

Figure 2

63-year old patient presenting with a day old chest pain. ECG shows ST elevation in inferior leads DII, DIII, aVF (red arrows) consistent with an inferior STEMI. Angiogram shows acute occlussion on the right coronary artery (blue arrow – left image) and chronic occlussion of the left anterior descending coronary artery (blue arrow – right image).

Biomarkers in MINOCA_

BiomarkersMechanismsChanges in MINOCAEffect on prognosis
C-reactive protein (CRP) 5 6, 73Vascular and myocardial inflammationIn MINOCA vs. MI-CADElevated risk of mortality and MACE
Tumor necrosis factor α (TNF-α) 53

  • induces endothelial damage,

  • reduces nitric oxide

  • bioavailability promotes vascular inflammation

In MINOCA vs MI-CADUnknown
Interleukin-6 (IL-6) 21, 54

  • increases coronary microvascular resistance

  • impairs coronary vasodilatation

In CMVDElevated risk of recurrent myocardial infarction
Interleukin-1 (IL-1) 55, 56

  • pro-thrombotic effect

  • increases expression of adhesion molecules

  • increases endothelial permeability

In MINOCAUnknown
Visfatin 58

  • promotes endothelial disfunction

  • inflammation

In MINOCAUnknown
Placental growth factor (PIGF) 58

  • monocyte infiltration

  • angiogenesis

In MINOCAUnknown
Fractalkine 58

  • vascular inflammation

  • endothelial activation

In MINOCAUnknown
Fibrinogen-on-albumin ratio (FAR) 74

  • coagulation cascade

-Higher risk of MACE and hospitalization for heart failure
sVCAM-1 55

  • leukocyte infiltration

  • vascular inflammation

In MINOCA vs MI-CADProgression of atherosclerosis
Soluble urokinase-type plasminogen activator receptor (suPAR) 80

  • inflammation

In MINOCA vs. healthy controlIncrease in MACE and all-cause deaths.
Uric acid 79

  • inflammation

-Higher risk of MACE and heart failure
Lipoprotein(a) 69, 70

  • lipid metabolism

In MINOCA vs MI-CADIncrease in MACE
Ratio of neutrophils, monocytes, lymphocytes, platelet to HDL (NHR, MHR, LHR, PHR) 75

  • oxidative stress

 Increase in MACE
Systemic inflammation response index (SIRI) 76--Higher rates of MACE
Neutrophil-to-lymphocyte ratio (NLR) 77

  • inflammation

In MINOCAIncreased risk of all-cause mortality
White blood cell count to mean platelet count ratio (WMR) 78

  • inflammation

-Higher rates of MACE
Neutrophil-to-platelet ratio 78

  • inflammation

-Higher rates of MACE
DOI: https://doi.org/10.2478/rjc-2025-0016 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Page range: 175 - 187
Published on: Sep 30, 2025
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
MINOCA,
MICAD,
inflammation,
endothelial dysfunction,
prognosis
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Surgery,
Cardiac surgery,
Pediatrics and juvenile medicine,
Paediatric cardiology

© 2025 Andra Ioana Stoenescu, Elena Barbu, Serban-Mihai Balanescu, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

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