Hôpital privé d’Antony, pôle cardiovasculaire Interventionnel (PCVI 92 et PCVI 77), 25, rue de la providence, 92160 Antony, France
Clinique les Fontaines, boulevard Aristide Briand, 77000 Melun, France
We report the observation of an acute coronary syndrome in an 84-year-old woman evolving to an anterior myocardial infarction with persistent elevation of the ST segment (STEMI), without significant stenosis of the left descending coronary artery after manual aspiration of a distal thrombus. The diagnostic workflow secondary to this clinical condition of MINOCA (Myocardial Infarction with Non Obstructive Coronary Arteries), integrated, according to the very latest definition of myocardial infarction, in the infarcts subgroup type 2 (not linked to an athero-thrombotic event) led to the very high probability of the diagnosis of coronary embolism related to a chronic and untreated atrial fibrillation. The purpose of this article is to provide a formal and updated definition for the broadly labelled term MINOCA (incorporating the definition of AMI from the newly released “Fourth Universal Definition of Myocardial Infarction”) and to provide a clinically useful framework and algorithms pertaining to the diagnostic evaluation and management of these patients.