冠状动脉非阻塞性心肌梗死（non‑obstructive myocardial infarction of the coronary artery，MINOCA）是一类在冠状动脉造影上表现为心外膜冠状动脉狭窄程度不超过50%的急性心肌梗死（acute myocardial infarction，AMI），约占AMI发生率的5%~15%。其病因高度异质，包括斑块破裂、斑块侵蚀、钙化结节、血管痉挛、微血管功能障碍、自发性冠状动脉夹层、冠状动脉栓塞或血栓形成等。不同病因的MINOCA患者预后存在明显差异。腔内影像技术，包括光学相干断层扫描和血管内超声在斑块病变、冠脉痉挛、自发性冠状动脉夹层和血栓的诊断中具有明显优势，但无法评估微血管功能障碍及非冠状动脉病因。尽管关于MINOCA的研究不断深入，针对其病因和腔内影像学特征的系统性研究仍然不足。本文综述了该领域关于MINOCA病因、腔内影像学特征及预后的最新研究进展，旨在提高临床医生对MINOCA的全面认识，并为制定相关二级预防策略提供理论依据。

Non‑obstructive myocardial infarction of the coronary artery （MINOCA） is a form of acute myocardial infarction （AMI） characterized by less than 50% stenosis on coronary angiography， accounting for approximately 5% to 15% of all AMI cases. Its etiology is highly heterogeneous， encompassing plaque rupture， plaque erosion， calcified nodules， vascular spasm， microvascular dysfunction， spontaneous coronary artery dissection， and coronary artery embolism or thrombosis， etc. The prognosis of MINOCA patients varies significantly depending on the underlying etiology. Intravascular imaging techniques， such as optical coherence tomography and intravascular ultrasound， offer significant advantages in diagnosing plaque lesions， coronary artery spasm， spontaneous coronary artery dissection， and thrombus. However， they are limited in assessing microvascular spasm and non‑coronary artery etiologies. Although research on MINOCA is ongoing， systematic investigations into its etiology and intravascular imaging characteristics remain limited. This review aims to synthesize recent research on the pathogenesis， intracoronary imaging findings， and clinical outcomes of MINOCA for the purpose of improving clinical recognition of physicians towards MINOCA and providing theoretical basis for developing relevant secondary prevention strategy.

R542.22

国家自然科学基金（82360063）；海南省自然科学基金（高层次人才项目）（821RC1127）；海南省重点研发项目（社会发展）（ZDYF2022SHFZ070）