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

Andra Ioana Stoenescu; Elena Barbu; Serban-Mihai Balanescu

doi:10.2478/rjc-2025-0016

References

Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic Review of Patients Presenting With Suspected Myocardial Infarction and Nonobstructive Coronary Arteries. Circulation. 2015;131(10): 861-70.
Search in Google Scholar Back to article
Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio ALP, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. European Heart Journal. 2016;38(3): 143-53.
Search in Google Scholar Back to article
Matter MA, Paneni F, Libby P, Frantz S, Stähli BE, Templin C, et al. Inflammation in acute myocardial infarction: the good, the bad and the ugly. European Heart Journal. 2023;45(2): 89-103.
Search in Google Scholar Back to article
Klingenberg R, Luscher TF. Inflammation in coronary artery disease and acute myocardial infarction - is the stage set for novel therapies? Curr Pharm Des. 2012;18(28): 4358-69.
Search in Google Scholar Back to article
Hjort M, Eggers KM, Lindhagen L, Agewall S, Brolin EB, Collste O, et al. Increased Inflammatory Activity in Patients 3 Months after Myocardial Infarction with Nonobstructive Coronary Arteries. Clin Chem. 2019;65(8): 1023-30.
Search in Google Scholar Back to article
Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, et al. Prognostic impact of inflammation in myocardial infarction with non-obstructive coronary arteries. European Heart Journal. 2023;44(Supplement_2).
Search in Google Scholar Back to article
Gaibazzi N, Martini C, Botti A, Pinazzi A, Bottazzi B, Palumbo AA. Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation in MINOCA and Tako-Tsubo Syndrome. J Am Heart Assoc. 2019;8(17): e013235.
Search in Google Scholar Back to article
Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. New England Journal of Medicine. 2017;377(12): 1119-31.
Search in Google Scholar Back to article
Gan J, Guo L, Zhang X, Yu Q, Yang Q, Zhang Y, et al. Anti-inflammatory therapy of atherosclerosis: focusing on IKKβ. Journal of Inflammation. 2023;20(1): 8.
Search in Google Scholar Back to article
Maguire EM, Pearce SWA, Xiao Q. Foam cell formation: A new target for fighting atherosclerosis and cardiovascular disease. Vascul Pharmacol. 2019;112:54-71.
Search in Google Scholar Back to article
Melamed KH, Goldhaber SZ. Inflammation and Myocardial Infarction. Circulation. 2014;130(24): e334-e6.
Search in Google Scholar Back to article
Zhang Q, Wang L, Wang S, Cheng H, Xu L, Pei G, et al. Signaling pathways and targeted therapy for myocardial infarction. Signal Transduct Target Ther. 2022;7(1): 78.
Search in Google Scholar Back to article
Zheng Y, Xu L, Dong N, Li F. NLRP3 inflammasome: The rising star in cardiovascular diseases. Front Cardiovasc Med. 2022;9: 927061.
Search in Google Scholar Back to article
Balanescu S, Barbu E, Georgescu C, Popescu AC. NLRP3 Inflammasome in Cardiovascular Disease: David’s Stone against Goliath? Romanian Journal of Cardiology. 2021;31(3): 517-27.
Search in Google Scholar Back to article
Takahashi M. Role of NLRP3 Inflammasome in Cardiac Inflammation and Remodeling after Myocardial Infarction. Biol Pharm Bull. 2019;42(4): 518-23.
Search in Google Scholar Back to article
Coste MER, França CN, Izar MC, Teixeira D, Ishimura ME, Longo-Maugeri I, et al. Early Changes in Circulating Interleukins and Residual Inflammatory Risk After Acute Myocardial Infarction. Arq Bras Cardiol. 2020;115(6): 1104-11.
Search in Google Scholar Back to article
Barbu E, Popescu MR, Popescu AC, Balanescu SM. Inflammation as A Precursor of Atherothrombosis, Diabetes and Early Vascular Aging. Int J Mol Sci. 2022;23(2).
Search in Google Scholar Back to article
Silvis MJM, Demkes EJ, Fiolet ATL, Dekker M, Bosch L, van Hout GPJ, et al. Immunomodulation of the NLRP3 Inflammasome in Atherosclerosis, Coronary Artery Disease, and Acute Myocardial Infarction. Journal of Cardiovascular Translational Research. 2021;14(1): 23-34.
Search in Google Scholar Back to article
Toldo S, Mezzaroma E, Buckley LF, Potere N, Di Nisio M, Biondi-Zoccai G, et al. Targeting the NLRP3 inflammasome in cardiovascular diseases. Pharmacol Ther. 2022;236: 108053.
Search in Google Scholar Back to article
Louwe MC, Olsen MB, Kaasbøll OJ, Yang K, Fosshaug LE, Alfsnes K, et al. Absence of NLRP3 Inflammasome in Hematopoietic Cells Reduces Adverse Remodeling After Experimental Myocardial Infarction. JACC: Basic to Translational Science. 2020;5(12): 1210-24.
Search in Google Scholar Back to article
Berg DD, O’Donoghue ML, Jarolim P, Guo J, Sabatine MS, Morrow DA. Biomarkers in the IL-6 Pathway and Cardiovascular Outcomes in Patients With STEMI in LATITUDE-TIMI 60. JACC Adv. 2024;3(4): 100866.
Search in Google Scholar Back to article
Koenig W. High-sensitivity C-reactive protein and atherosclerotic disease: from improved risk prediction to risk-guided therapy. Int J Cardiol. 2013;168(6):5126-34.
Search in Google Scholar Back to article
Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet. 2018;392(10151): 929-39.
Search in Google Scholar Back to article
Araki M, Sugiyama T, Nakajima A, Yonetsu T, Seegers LM, Dey D, et al. Level of Vascular Inflammation Is Higher in Acute Coronary Syndromes Compared with Chronic Coronary Disease. Circulation: Cardiovascular Imaging. 2022;15(11): e014191.
Search in Google Scholar Back to article
Sagris M, Antonopoulos AS, Simantiris S, Oikonomou E, Siasos G, Tsioufis K, et al. Pericoronary fat attenuation index-a new imaging biomarker and its diagnostic and prognostic utility: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2022;23(12): e526-e36.
Search in Google Scholar Back to article
Kain V, Prabhu SD, Halade GV. Inflammation revisited: inflammation versus resolution of inflammation following myocardial infarction. Basic Research in Cardiology. 2014;109(6): 444.
Search in Google Scholar Back to article
Haim M, Tanne D, Boyko V, Reshef T, Goldbourt U, Battler A, et al. Monocyte chemoattractant protein-1 and recurrent cardiovascular events in patients with stable coronary heart disease. Clinical Cardiology. 2005;28(1): 31-5.
Search in Google Scholar Back to article
Shantsila E, Lip GYH. Monocytes in Acute Coronary Syndromes. Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29(10): 1433-8.
Search in Google Scholar Back to article
Klingenberg R, Nitschmann S. [Colchicine treatment after myocardial infarction : Colchicine Cardiovascular Outcomes Trial (COLCOT)]. Internist (Berl). 2020;61(7): 766-9.
Search in Google Scholar Back to article
Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in Patients with Chronic Coronary Disease. New England Journal of Medicine. 2020;383(19): 1838-47.
Search in Google Scholar Back to article
Abbate A, Wohlford GF, Del Buono MG, Chiabrando JG, Markley R, Turlington J, et al. Interleukin-1 blockade with anakinra and heart failure following ST-segment elevation myocardial infarction: results from a pooled analysis of the VCUART clinical trials. Eur Heart J Cardiovasc Pharmacother. 2022;8(5): 503-10.
Search in Google Scholar Back to article
Del Buono MG, Damonte JI, Trankle CR, Kadariya D, Carbone S, Thomas G, et al. Effect of interleukin-1 blockade with anakinra on leukocyte count in patients with ST-segment elevation acute myocardial infarction. Scientific Reports. 2022;12(1): 1254.
Search in Google Scholar Back to article
Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. New England Journal of Medicine. 2008;359(21): 2195-207.
Search in Google Scholar Back to article
Gao R, Shi H, Chang S, Gao Y, Li X, Lv C, et al. The selective NLRP3-inflammasome inhibitor MCC950 reduces myocardial fibrosis and improves cardiac remodeling in a mouse model of myocardial infarction. Int Immunopharmacol. 2019;74: 105575.
Search in Google Scholar Back to article
Bromage DI, Pareek N, Cannata A, Ameri P. Targeting Inflammation After Myocardial Infarction—Another Piece of the Puzzle. Journal of Cardiovascular Pharmacology. 2022;79(6): 769-71.
Search in Google Scholar Back to article
Yildiz M, Ashokprabhu N, Shewale A, Pico M, Henry TD, Quesada O. Myocardial infarction with non-obstructive coronary arteries (MINOCA). Frontiers in Cardiovascular Medicine. 2022;9.
Search in Google Scholar Back to article
Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjöld A, Gard A, et al. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Circulation. 2017;135(16): 1481-9.
Search in Google Scholar Back to article
Yaker ZS, Lincoff AM, Cho L, Ellis SG, Ziada KM, Zieminski JJ, et al. Coronary spasm and vasomotor dysfunction as a cause of MINOCA. EuroIntervention. 2024;20(2): e123-e34.
Search in Google Scholar Back to article
Nobuyoshi M, Abe M, Nosaka H, Kimura T, Yokoi H, Hamasaki N, et al. Statistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant. Am Heart J. 1992;124(1): 32-8.
Search in Google Scholar Back to article
Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Cammà G, et al. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. European Heart Journal. 2017;39(2): 91-8.
Search in Google Scholar Back to article
Hung MJ, Cherng WJ. Coronary Vasospastic Angina: Current Understanding and the Role of Inflammation. Acta Cardiol Sin. 2013;29(1): 1-10.
Search in Google Scholar Back to article
Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019;139(18): e891-e908.
Search in Google Scholar Back to article
Reynolds HR, Maehara A, Kwong RY, Sedlak T, Saw J, Smilowitz NR, et al. Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women. Circulation. 2021;143(7): 624-40.
Search in Google Scholar Back to article
Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, et al. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism. Circulation. 2015;132(4): 241-50.
Search in Google Scholar Back to article
Opolski MP, Spiewak M, Marczak M, Debski A, Knaapen P, Schumacher SP, et al. Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease: Results From the Optical Coherence Tomography Study. JACC: Cardiovascular Imaging. 2019;12(11, Part 1): 2210-21.
Search in Google Scholar Back to article
Stepien K, Nowak K, Wypasek E, Zalewski J, Undas A. High prevalence of inherited thrombophilia and antiphospholipid syndrome in myocardial infarction with non-obstructive coronary arteries: Comparison with cryptogenic stroke. Int J Cardiol. 2019;290: 1-6.
Search in Google Scholar Back to article
Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, et al. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc. 2018;7(13).
Search in Google Scholar Back to article
Ouldzein H, Elbaz M, Roncalli J, Cagnac R, Carrié D, Puel J, et al. Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: Analysis by intravascular ultrasound. Annales de Cardiologie et d ‘Angéiologie. 2012;61(1): 20-6.
Search in Google Scholar Back to article
Sucato V, Testa G, Puglisi S, Evola S, Galassi AR, Novo G. Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management. Journal of Cardiology. 2021;77(5): 444-51.
Search in Google Scholar Back to article
Ciliberti G, Finocchiaro G, Guerra F, Papadakis M, Sharma S, Sheppard M. Different clinical and pathological profiles of sudden cardiac death victims caused by coronary artery dissection or myocardial infarction with non-obstructed coronary arteries. European Heart Journal. 2022;43(Supplement_2).
Search in Google Scholar Back to article
Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018;137(19): e523-e57.
Search in Google Scholar Back to article
Tweet MS, Eleid MF, Best PJM, Lennon RJ, Lerman A, Rihal CS, et al. Spontaneous Coronary Artery Dissection. Circulation: Cardiovascular Interventions. 2014;7(6):777-86.
Search in Google Scholar Back to article
Espinosa Pascual MJ, Martin Munoz M, El Assar De La Fuente M, Nieto Ibanez D, Camara Hernandez V, Carnicero Carreno J, et al. Increased circulating levels of standardized inflammatory and endothelial dysfunction biomarkers in patients with myocardial infarction with nonobstructive coronary arteries. European Heart Journal. 2024;45(Supplement_1).
Search in Google Scholar Back to article
Fanola CL, Morrow DA, Cannon CP, Jarolim P, Lukas MA, Bode C, et al. Interleukin-6 and the Risk of Adverse Outcomes in Patients After an Acute Coronary Syndrome: Observations From the SOLID-TIMI 52 (Stabilization of Plaque Using Darapladib—Thrombolysis in Myocardial Infarction 52) Trial. Journal of the American Heart Association. 2017;6(10): e005637.
Search in Google Scholar Back to article
Ryabov VV, Vorobeva DA, Kologrivova IV, Suslova TE. Pro-Inflammatory Biomarkers and Progression of Atherosclerosis in Patients with Myocardial Infarction with Non-Obstructive Coronary Artery Disease: 1-Year Follow-Up. J Pers Med. 2023;13(12).
Search in Google Scholar Back to article
Ciliberti G, Bergamaschi L, Armillotta M, Angeli F, Pizzi C. MINOCA and inflammation: Another piece of the puzzle. International Journal of Cardiology. 2025;419.
Search in Google Scholar Back to article
Haybar H, Bandar B, Torfi E, Mohebbi A, Saki N. Cytokines and their role in cardiovascular diseases. Cytokine. 2023;169: 156261.
Search in Google Scholar Back to article
Stangret A, Dykacz W, Jabłoński K, Wesołowska A, Klimczak-Tomaniak D, Kochman J, et al. The cytokine trio - visfatin, placental growth factor and fractalkine – and their role in myocardial infarction with non-obstructive coronary arteries (MINOCA). Cytokine & Growth Factor Reviews. 2023;74: 76-85.
Search in Google Scholar Back to article
Espinosa Pascual MJ, Lopez Pais J, Izquierdo Coronel B, Nieto Ibanez D, Galan Gil D, Perela Alvarez C, et al. Role of inflammation in Myocardial Infarction with Non-Obstructive Coronary Arteries. European Heart Journal. 2021;42(Supplement_1).
Search in Google Scholar Back to article
Pasqualetto MC, Tuttolomondo D, Cutruzzolà A, Niccoli G, Dey D, Greco A, et al. Human coronary inflammation by computed tomography: Relationship with coronary microvascular dysfunction. Int J Cardiol. 2021;336: 8-13.
Search in Google Scholar Back to article
Zhang S, Zhang X, Wu S, Zhang T, Ji HM, Zhang Q, et al. [Analysis of clinical features and the outcome of in-hospital mortality of myocardial infarction with non-obstructive coronary arteries]. Zhonghua Xin Xue Guan Bing Za Zhi. 2022;50(9): 873-80.
Search in Google Scholar Back to article
Pelliccia F, Pasceri V, Niccoli G, Tanzilli G, Speciale G, Gaudio C, et al. Predictors of Mortality in Myocardial Infarction and Nonobstructed Coronary Arteries: A Systematic Review and Meta-Regression. The American Journal of Medicine. 2020;133(1): 73-83.e4.
Search in Google Scholar Back to article
Nordenskjöld AM, Baron T, Eggers KM, Jernberg T, Lindahl B. Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. Int J Cardiol. 2018;261: 18-23.
Search in Google Scholar Back to article
Canton L, Fedele D, Bergamaschi L, Foà A, Di Iuorio O, Tattilo FP, et al. Sex- and age-related differences in outcomes of patients with acute myocardial infarction: MINOCA vs. MIOCA. European Heart Journal Acute Cardiovascular Care. 2023;12(9): 604-14.
Search in Google Scholar Back to article
Chaudhary R, Bashline M, Novelli EM, Bliden KP, Tantry US, Olafiranye O, et al. Sex-related differences in clinical outcomes among patients with myocardial infarction with nonobstructive coronary artery disease: A systematic review and meta-analysis. International Journal of Cardiology. 2022;369: 1-4.
Search in Google Scholar Back to article
Tsaban G, Barret O, Peles I, Abramowitz Y, Shmueli H, Cafri C, et al. Prognostic factors of patients with myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up. European Heart Journal. 2022;43(Supplement_2).
Search in Google Scholar Back to article
Chen L, Fan Y, Fang Z, Liu N. Long-term outcomes and predictors of patients with ST elevated versus non-ST elevated myocardial infarctions in non-obstructive coronary arteries: a retrospective study in Northern China. PeerJ. 2023;11: e14958.
Search in Google Scholar Back to article
Gao S, Xu H, Ma W, Yuan J, Yu M. Remnant Cholesterol Predicts Risk of Cardiovascular Events in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. Journal of the American Heart Association. 2022;11(10): e024366.
Search in Google Scholar Back to article
Gao S, Ma W, Huang S, Lin X, Yu M. Effect of Lipoprotein (a) Levels on Long-term Cardiovascular Outcomes in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries. The American Journal of Cardiology. 2021;152: 34-42.
Search in Google Scholar Back to article
Kallmeyer A, Pello Lázaro AM, Blanco-Colio LM, Aceña Á, González-Lorenzo Ó, Tarín N, et al. Absence of High Lipoprotein(a) Levels Is an Independent Predictor of Acute Myocardial Infarction without Coronary Lesions. Journal of Clinical Medicine. 2023;12(3): 960.
Search in Google Scholar Back to article
Kong M, Pei Z, Xie Y, Gao Y, Li J, He G. Prognostic factors of MINOCA and their possible mechanisms. Preventive Medicine Reports. 2024;39: 102643.
Search in Google Scholar Back to article
Hjort M, Eggers KM, Lakic TG, Lindbäck J, Budaj A, Cornel JH, et al. Biomarker Concentrations and Their Temporal Changes in Patients With Myocardial Infarction and Nonobstructive Compared With Obstructive Coronary Arteries: Results From the PLATO Trial. Journal of the American Heart Association. 2023;12(1): e027466.
Search in Google Scholar Back to article
Eggers KM, Baron T, Hjort M, Nordenskjöld AM, Tornvall P, Lindahl B. Clinical and prognostic implications of C-reactive protein levels in myocardial infarction with nonobstructive coronary arteries. Clin Cardiol. 2021;44(7): 1019-27.
Search in Google Scholar Back to article
Fang Y, Huang S, Zhang H, Yu M. The association between fibrinogen-to-albumin ratio and adverse prognosis in patients with myocardial infarction with non-obstructive coronary arteries. Int J Cardiol. 2025;418: 132665.
Search in Google Scholar Back to article
Zhou H, Li X, Wang W, Zha Y, Gao G, Li S, et al. Immune-inflammatory biomarkers for the occurrence of MACE in patients with myocardial infarction with non-obstructive coronary arteries. Frontiers in Cardiovascular Medicine. 2024;11.
Search in Google Scholar Back to article
Hou H, Xu Y, Chen G, Yao H, Bi F. Prognostic Value of Systemic Inflammation Response Index and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries-A Retrospective Study. J Inflamm Res. 2024;17: 8281-98.
Search in Google Scholar Back to article
Gürdal A, Keskin K, Siğirci S, Yildiz SS, Kiliçkesmez KO. Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries. Angiology. 2020;71(9): 812-6.
Search in Google Scholar Back to article
Mohammed AA, Liu L, Mareai RM, Mohammed AQ, Yin G, Singh S, et al. Combination of White Blood Cell Count to Mean Platelet Volume Ratio and Neutrophil-to-Platelet Ratio Predicts Long-Term Adverse Events in Patients with MINOCA. Mediators Inflamm. 2022;2022: 5642406.
Search in Google Scholar Back to article
Ma W, Gao S, Huang S, Yuan J, Yu M. Hyperuricemia as a prognostic marker for long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Nutrition & Metabolism. 2021;18(1): 107.
Search in Google Scholar Back to article
Al-Badri A, Tahhan AS, Sabbak N, Alkhoder A, Liu C, Ko YA, et al. Soluble Urokinase-Type Plasminogen Activator Receptor and High-Sensitivity Troponin Levels Predict Outcomes in Nonobstructive Coronary Artery Disease. Journal of the American Heart Association. 2020;9(8): e015515.
Search in Google Scholar Back to article
Bergamaschi L, Foà A, Paolisso P, Renzulli M, Angeli F, Fabrizio M, et al. Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC: Cardiovascular Imaging. 2024;17(2):149-61.
Search in Google Scholar Back to article
Zeng M, Zhao C, Bao X, Liu M, He L, Xu Y, et al. Clinical Characteristics and Prognosis of MINOCA Caused by Atherosclerotic and Nonatherosclerotic Mechanisms Assessed by OCT. JACC: Cardiovascular Imaging. 2023;16(4): 521-32.
Search in Google Scholar Back to article

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

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