Psychological Trauma as a Risk Factor for Acute Coronary Syndromes: A Scoping Review with Implications for Women with (M)INOCA

This scoping review aims to systematically map and synthesize the existing literature examining psychological trauma and trauma-related stress exposures as risk factors for acute coronary syndromes (ACS). The primary objective is to characterize how these exposures are associated with the onset of ACS, with particular attention to non-obstructive presentations, including myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary arteries (INOCA). The review will examine how trauma, resilience, and coping are defined and measured across studies, identifying inconsistencies and gaps in conceptualization and operationalization. It will also summarize proposed biological and psychosocial mechanisms through which trauma and trauma-linked stress may influence ACS risk, including stress-related physiological responses, autonomic dysregulation, inflammatory processes, and behavioural pathways. Social identity factors, including sex and gender, will be considered to explore potential differences in risk, presentation, and outcomes. By integrating evidence across diverse study designs and disciplines, this review seeks to clarify the role of trauma-related exposures in ACS risk, identify potential protective psychosocial factors, and highlight gaps in definitions, measurement approaches, and current knowledge to inform future research and clinical practice.