Non-atherosclerotic myocardial infarction in hypereosinophilic syndrome: emerging insights and therapeutic approaches.

Hypereosinophilic syndrome (HES) is a heterogeneous disorder characterised by persistent, abnormal eosinophil elevation in blood and tissues, with multisystem involvement. Cardiac manifestations are frequent in HES and significantly worsen prognosis. Recent evidence establishes a direct link between HES and myocardial infarction (MI), demonstrating that HES induces MI primarily via non-atherosclerotic mechanisms. Critically, HES-related MI is fundamentally distinct from atherosclerotic MI in pathogenesis, diagnosis and management. This paradigm shift redefines diagnostic frameworks for cardiovascular disease and provides targeted strategies for non-atherosclerotic MI. This review synthesises current knowledge on HES-associated MI, emphasising its unique epidemiology, pathophysiology, evidence-based diagnostic criteria and mechanism-specific therapies. Future research priorities are discussed to advance clinical translation.