The Myth of Myocardial Infarction With Normal Coronary Angiography

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Apr 7

PMID 33824813

Citations 1

Authors

Ziad A Taher

Abdulhalim J Kinsara

Affiliations

Soon will be listed here.

Abstract

Myocardial infarction with no obstructive atherosclerosis is an increasingly recognized presentation of acute coronary syndrome (ACS). The disease has all the clinical features of an ACS, but the only exception is that the coronary angiogram indicates non-obstructive coronary artery disease. Although different pathophysiological mechanisms have been postulated, no definitive mechanism has been identified. Consequently, the treatment plan varies and depends on the more probable mechanism. Here, we review the current body of knowledge about this disease and discuss updated management strategies.

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References

Reynolds H, Srichai M, Iqbal S, Slater J, Mancini G, Feit F . Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011; 124(13):1414-25. PMC: 3619391. DOI: 10.1161/CIRCULATIONAHA.111.026542. View

Lanza G, Sestito A, Sgueglia G, Infusino F, Manolfi M, Crea F . Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina. Int J Cardiol. 2006; 118(1):41-7. DOI: 10.1016/j.ijcard.2006.06.016. View

Pristipino C, Beltrame J, Finocchiaro M, Hattori R, Fujita M, Mongiardo R . Major racial differences in coronary constrictor response between japanese and caucasians with recent myocardial infarction. Circulation. 2000; 101(10):1102-8. DOI: 10.1161/01.cir.101.10.1102. View

Pasupathy S, Air T, Dreyer R, Tavella R, Beltrame J . Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015; 131(10):861-70. DOI: 10.1161/CIRCULATIONAHA.114.011201. View

Tayal B, Freeman P, Ericsson F, Kragholm K, Andersen N, Hagendorff A . Characterisation of patients with and without cardiac magnetic resonance imaging abnormalities presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). Acta Cardiol. 2020; 76(7):760-768. DOI: 10.1080/00015385.2020.1785134. View

Tweet M, Hayes S, Pitta S, Simari R, Lerman A, Lennon R . Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012; 126(5):579-88. DOI: 10.1161/CIRCULATIONAHA.112.105718. View

Scalone G, Niccoli G, Crea F . Editor's Choice- Pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care. 2018; 8(1):54-62. DOI: 10.1177/2048872618782414. View

Kang W, Jeong M, Ahn Y, Kim J, Chae S, Kim Y . Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe?. Int J Cardiol. 2009; 146(2):207-12. DOI: 10.1016/j.ijcard.2009.07.001. View

Bugiardini R, Manfrini O, De Ferrari G . Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography. Arch Intern Med. 2006; 166(13):1391-5. DOI: 10.1001/archinte.166.13.1391. View

10.

Tornvall P, Gerbaud E, Behaghel A, Chopard R, Collste O, Laraudogoitia E . Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data. Atherosclerosis. 2015; 241(1):87-91. DOI: 10.1016/j.atherosclerosis.2015.04.816. View

11.

Rossini R, Capodanno D, Lettieri C, Musumeci G, Limbruno U, Molfese M . Long-term outcomes of patients with acute coronary syndrome and nonobstructive coronary artery disease. Am J Cardiol. 2013; 112(2):150-5. DOI: 10.1016/j.amjcard.2013.03.006. View

12.

Gehrie E, Reynolds H, Chen A, Neelon B, Roe M, Gibler W . Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with.... Am Heart J. 2009; 158(4):688-94. DOI: 10.1016/j.ahj.2009.08.004. View

13.

Glaveckaite S, Serpytis P, Peciuraite D, Puronaite R, Valeviciene N . Clinical features and three-year outcomes of Takotsubo (stress) cardiomyopathy: Observational data from one center. Hellenic J Cardiol. 2017; 57(6):428-434. DOI: 10.1016/j.hjc.2016.11.016. View

14.

Elesber A, Prasad A, Lennon R, Wright R, Lerman A, Rihal C . Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol. 2007; 50(5):448-52. DOI: 10.1016/j.jacc.2007.03.050. View

15.

Planer D, Mehran R, Ohman E, White H, Newman J, Xu K . Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circ Cardiovasc Interv. 2014; 7(3):285-93. DOI: 10.1161/CIRCINTERVENTIONS.113.000606. View

16.

Saw J, Aymong E, Sedlak T, Buller C, Starovoytov A, Ricci D . Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014; 7(5):645-55. DOI: 10.1161/CIRCINTERVENTIONS.114.001760. View

17.

Prasad A . Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation. 2007; 115(5):e56-9. DOI: 10.1161/CIRCULATIONAHA.106.669341. View

18.

Templin C, Ghadri J, Diekmann J, Napp L, Bataiosu D, Jaguszewski M . Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015; 373(10):929-38. DOI: 10.1056/NEJMoa1406761. View

19.

Kaski J, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S . Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina. Circulation. 1986; 74(6):1255-65. DOI: 10.1161/01.cir.74.6.1255. View

20.

Takarada S, Imanishi T, Ishibashi K, Tanimoto T, Komukai K, Ino Y . The effect of lipid and inflammatory profiles on the morphological changes of lipid-rich plaques in patients with non-ST-segment elevated acute coronary syndrome: follow-up study by optical coherence tomography and intravascular ultrasound. JACC Cardiovasc Interv. 2010; 3(7):766-72. DOI: 10.1016/j.jcin.2010.05.001. View