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Some peculiarities of acute myocardial infarction pathogenesis in non-obstructive coronary arteries

[Internal diseases]
Nikita Dyatlov; Yuriy Lykov; Vladimir Zhelnov; Leonid Dvoretsky;

Myocardial infarctions (MI) in case of non-obstructive atherosclerosis or intact coronary arteries are set apart into a separate group – myocardial infarction with no-obstructive coronary atherosclerosis – MINOCA. 1240 patients were included. The first group comprised the patients with single-vessel disease and complete acute occlusion – infarction of the responsible coronary artery (myocardial infarction with obstructive coronary atherosclerosis – MIOCA) 21.9 %. The second group comprised the patients with MINOCA 7.7 %. The average age of patients in Group 1 was 56.59±11.6 years, in Group 2 it amounted to 67.9±11.5 (p<0.001). Diabetes, CKD, exertional angina, symptoms of CHF and arterial hypertension were more likely for patients with MINOCA as compared to MIOCA – 20.8 % vs 7.4 % (p<0.05), 25.0 % vs 11.8 % (p<0.05), 29.2 % vs 14.7 % (p<0.05), 41.7 % vs 17.6 % (p<0.05) 91.7 % vs 72.1 % (p<0.01) respectively. Several mechanisms of myocardial necrosis were discussed: plaque disruption without the obstruction of coronary artery lumen and/or spontaneous thrombolysis, spontaneous intima dissection, infection, myocardial bridge, vasospasm. Thus, the pathogenesis of necrosis in patients with MINOCA is ambivalent and one patient may have combination of various pathogenic mechanisms, which makes the process of diagnostics and the selection of adequate treatment more complicated.

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References:
1. Agewall S., Beltrame J. F., Reynolds H. R. [et al.] ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur. Heart. J. 2017;38(3):143-153. doi: 10.1093/eurheartj/ehw149
2. Bugiardini R., Bairey Merz C. N. Angina with «normal» coronary arteries: a changing philosophy. JAMA 2005;293:477–484. doi: 10.1001/jama.293.4.477
3. Bugiardini R., Manfrini O., De Ferrari G. M. 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;166:1391–1395. doi: 10.1001/archinte.166.13.1391
4. Escolar E., Weigold G., Fuisz A [et al.] New imaging techniques for diagnosing coronary artery disease. CMAJ. 2006;174:487–495. doi: 10.1503/cmaj.050925
5. Gehrie E. R., Reynolds H. R., Chen A. Y. [et al.] 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 Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Am. Heart. J. 2009;158:688–694. doi: 10.1016/j.ahj.2009.08.004
6. Hwang In-Chang. Statin therapy is associated with lower all-cause mortality in patients with nonobstructive coronary artery disease. Atherosclerosis 2015;239(2):335–342. doi: 10.1016/j.atheroscle-rosis. 2015.01.036
7. Jia H., Abtahian F., Aguirre A. D. [et al.] In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J. Am. Coll. Cardiol. 2013 Nov 5;62(19):1748-1758. doi: 10.1016/j.jacc.2013.05.071
8. Kardasz I., R. De Caterina. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. JIM. 2007;261(4):330-348. doi: 10.1111/j.1365-2796.2007.01788.x
9. Masanobu I., Koichi K., Koji S. [et al.] Impact of aspirin on the prognosis in patients with coronary spasmwithout significant atherosclerotic stenosis. IJC. 2016;220:328-332. doi: 10.1016/j.ijcard.2016.06.157
10. Ohba K., Seigo S., Hitoshi S. [et al.] Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease. J. Am. Heart. Assoc. 2012;1:e002485. doi: 10.1161/JAHA.112.002485
11. Okazaki S., Yokoyama T., Miyauchi K. [et al.] Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study. Circulation. 2004;110(9):1061-1068. doi: 10.1161/01.CIR.0000140261.58966.A4
12. Ouldzein H., Elbaz M., Roncalli J. [et al.] Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: analysis by intravascular ultrasound. Ann. Cardiol. Angeiol. (Paris) 2012;61:20–26. doi: 10.1016/j.ancard.2011.07.011
13. Raggi P., Taylor A., Fayad Z. [et al.] Atherosclerotic plaque imaging: contemporary role in preventive cardiology. Arch. Intern. Med. 2005;165:2345–2353. doi: 10.1001/archinte.165.20.2345
14. Reynolds H. R., Srichai M. B., Iqbal S. N. [et al.] Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124:1414–1425. doi: 10.1161/CIRCULATIONAHA.111.026542
15. Roberts James R. Angiotensin-Converting Enzyme (ACE) Inhibitor Angioedema: The Silent Epidemic. AJC. 2012; 109 (5):774–775. doi: 10.1016/j.amjcard.2011.11.014
16. Taher T., Fu Y., Wagner G. [et al.] Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regiment-3 rial Electrocardiographis Substudy. J. Am. Coll. Cardiol. 2004;44:38–43. doi: 10.1016/j.jacc.2004.03.041
17. Terkelsen C. J., Norgaard B. L., Lassen J. F. [et al.] Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study). European Heart J. 2006;27:267–275. doi: 10.1093/eurheartj/ehi606
18. Thygesen K., Joseph S. Alpert, Allan S. Jaffe [et al.] Third Universal Definition of Myocardial Infarction. Circulation. 2012;126:2020-2035. doi: 10.1161/CIR.0b013e31826e1058
19. Ueda Y., Hinoi T., Matsuo S. [et al.] Intravascular ultrasoundguided coronary artery stenting for spontaneous coronary artery dissection in a case of acute myocardial infarction associated with vasospasm in a non-culprit coronary artery during the hospitalization. Intern. Med. 2006;45:763–767. doi: 10.2169/internalmedicine. 45.1688

Keywords: myocardial infarction, non-obstructive coronary atherosclerosis, intact coronary arteries


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