Incidence and follow up outcomes of myocardial infarction with non obstructive coronary artery disease entity after pharmacological thrombolysis

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

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A serial optical frequency-domain imaging study of early and late vascular responses to bioresorbable-polymer sirolimus-eluting stents for the treatment of acute myocardial infarction and stable coronary artery disease patients: results of the MECHANISM-ULTIMASTER study

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-021-00777-4 ◽

2021 ◽

Author(s):

Tomonori Itoh ◽

◽

Hiromasa Otake ◽

Takumi Kimura ◽

Yoshiro Tsukiyama ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Frequency Domain ◽

Stable Coronary Artery Disease ◽

Imaging Study ◽

Optical Frequency ◽

Bioresorbable Polymer ◽

Artery Disease

AbstractThe purpose of this study was to assess early and late vascular healing in response to bioresorbable-polymer sirolimus-eluting stents (BP-SESs) for the treatment of patients with ST-elevation myocardial infarction (STEMI) and stable coronary artery disease (CAD). A total of 106 patients with STEMI and 101 patients with stable-CAD were enrolled. Optical frequency-domain images were acquired at baseline, at 1- or 3-month follow-up, and at 12-month follow-up. In the STEMI and CAD cohorts, the percentage of uncovered struts (%US) was significantly and remarkably decreased during early two points and at 12-month (the STEMI cohort: 1-month: 18.75 ± 0.78%, 3-month: 10.19 ± 0.77%, 12-month: 1.80 ± 0.72%; p < 0.001, the CAD cohort: 1-month: 9.44 ± 0.78%, 3-month: 7.78 ± 0.78%, 12-month: 1.07 ± 0.73%; p < 0.001 respectively). The average peri-strut low-intensity area (PLIA) score in the STEMI cohort was significantly decreased during follow-up period (1.90 ± 1.14, 1.18 ± 1.25, and 1.01 ± 0.72; p ≤ 0.001), whereas the one in the CAD cohort was not significantly changed (0.89 ± 1.24, 0.67 ± 1.07, and 0.64 ± 0.72; p = 0.59). In comparison with both groups, differences of %US and PLIA score at early two points were almost disappeared or close at 12 months. The strut-coverage and healing processes in the early phase after BP-SES implantation were significantly improved in both cohorts, especially markedly in STEMI patients. At 1 year, qualitatively and quantitatively consistent neointimal coverage was achieved in both pathogenetic groups.

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RISE AND/OR FALL IN THE SERIAL TROPONIN VALUES LACK CORRELATION WITH THE INCIDENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60141-3 ◽

2015 ◽

Vol 65 (10) ◽

pp. A141

Author(s):

Naoki Misumida ◽

Akihiro Kobayashi ◽

Yumiko Kanei

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Artery Disease

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Abstract 13804: Clinical Profile and Outcomes of Myocardial Infarction With Non-obstructive Coronary Arteries in Older Adults

Circulation ◽

10.1161/circ.142.suppl_3.13804 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ara H Rostomian ◽

Derek Q Phan ◽

Mingsum Lee ◽

Ray X Zadegan

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Los Angeles ◽

Coronary Arteries ◽

Medical Center ◽

Invasive Coronary Angiography ◽

Obstructive Coronary Artery Disease ◽

Kaiser Permanente ◽

Artery Disease

Introduction: Myocardial Infarction with non-obstructive coronary artery disease (MINOCA) is found in 5%-6% of patients with acute myocardial infarction (AMI). As such, the diagnosis and management of AMI patients with non-obstructive coronary artery disease (NOCAD) poses a challenge as compared to patients with MI with coronary artery disease (MICAD). Hypothesis: To evaluate the characteristics and outcomes of MINOCA in older patients as compared with MICAD patients, with and without revascularization. Methods: This was a retrospective observational study of patients ≥80 years old who underwent invasive coronary angiography (ICA) for AMI between 2009-2019 at Kaiser Permanente Los Angeles Medical Center. MINOCA was defied as <50% stenosis of coronary arteries on angiography with a troponin level ≥0.05 ng/ml. Patients with MINOCA vs MICAD were compared. Multivariate logistic regression was used to identify independent predictors of MINOCA and Kaplan-Meier survival analysis was used to analyze all-cause mortality between cohorts. Results: A total of 259 patients with MINOCA (mean ± SD age 83.8±2.7 years, 68% female) and 687 patients with MICAD (84.7±3.4 years, 40% female) were analyzed. Younger age (odds ratio [OR]=1.11; 95% confidence interval [CI]=1.05-1.18), female sex (OR=3.14; CI=2.20-4.48), black race (OR=2.53; CI=1.61-3.98), no history of prior stroke (OR=1.56; CI=1.06-2.33), atrial fibrillation or flutter (OR=2.04; CI:1.38-3.02), lower troponin levels (OR=1.08; CI:1.03-1.11), and lower triglyceride levels per 10 mg/dl increments (OR=1.06; CI:1.03-1.11) increased the odds of having MINCOA as compared to MICAD. At median follow-up of 2.4 years, MINOCA was associated with a lower rate of death (44.8% vs 55.2%, p<0.01) compared to un-revascularized MICAD, but no difference (31.3% vs 40.4%, p=0.68) when compared to re-vascularized MICAD. Conclusions: Patients age ≥80 years with MINOCA have fewer traditional risk factors compared to their counterparts with MICAD and fewer deaths compared to un-revascularized MICAD, but similar mortality compared to revascularized MICAD

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19 MULTIPLE SITES OF CARDIAC RUPTURE IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION WITH NON-OBSTRUCTIVE CORONARY ARTERY DISEASE

Journal of Investigative Medicine ◽

10.2310/6650.2005.00006.18 ◽

2005 ◽

Vol 53 (1) ◽

pp. S257.2-S257

Author(s):

A. P. Mehrle ◽

M. D. Winniford ◽

M. R. McMullan ◽

T. N. Skelton

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

Cardiac Rupture ◽

Artery Disease

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Ischaemic heart disease in women

ESC CardioMed ◽

10.1093/med/9780198784906.003.0679 ◽

2018 ◽

pp. 2836-2840

Author(s):

Martha Gulati

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Heart Disease ◽

Coronary Artery ◽

Ischaemic Heart Disease ◽

Obstructive Coronary Artery Disease ◽

Diagnostic Testing ◽

Atypical Presentation ◽

Artery Disease

The more atypical presentation of women makes the diagnostic evaluation of symptomatic women challenging and results in more frequent referral for diagnostic testing to improve the precision of the ischaemic heart disease likelihood estimate. The classification of ischaemic heart disease and myocardial infarction has moved beyond the diagnosis of obstructive coronary artery disease and encompasses ischaemia that can occur in the presence and absence of obstructive coronary artery disease. Consideration of the different pathophysiology of ischaemia that may occur in women needs to be considered in the evaluation and treatment of ischaemic heart disease in women.

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