Management of patients with myocardial infarction and nonobstructive coronary arteries: literature review and own data

2021 ◽  
Author(s):  
O. O. Khaniukov ◽  
L. V. Sapozhnychenko ◽  
M. V. Sаmilyk ◽  
K. D. Perepelytsia
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Chronic Heart Failure ◽  
Coronary Arteries ◽  
Large Scale ◽  
Obstructive Coronary Artery Disease ◽  
Artery Dissection

Over the past few years, much attention has been paid to the diagnosis and treatment of myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA). Its prevalence achieves 5 — 15 %, and impact of risk factors of cardiovascular disease development on the MINOCA onset has some specific features. The following criteria are required to diagnose MINOCA: compliance with the MI criteria, absence of obstructive coronary artery disease (≥ 50 %) and exclusion of an alternative diagnosis. Myocardial ischemia is the underlying cause of cardiomyocyte damage during MINOCA. It can be caused by coronary artery thrombosis due to the rupture of atherosclerotic plaque (type 1 MI), spasm or spontaneous coronary artery dissection (type 2 MI). The aim of our study was to analyse risk factors and the incidence of MINOCA in patients with acute myocardial infarction. A retrospective analysis has been performed on 1358 histories of patients with MI who were hospitalized in Dnipropetrovsk Regional Clinical Center of Cardiology and Cardiac Surgery during the period of 2019 — 2020 years. From them, 60 (4.4 %) patients were selected based on MINOCA diagnostic criteria according to the European Society of Cardiology (2018). The mean age of patients was 58.6 ± 14 years. ST‑segment elevation MI (STEMI) was diagnosed in 87.2 %. Cardiac and non‑cardiac comorbidity has been investigated with the following results: atrial fibrillation (AF) was revealed in 13.3 % of patients, hypertension (AH) — in 85 %, history of coronary heart disease (CHD) — in 31.7 %, recurrent MI — in 11.7 %, chronic heart failure (CHF) — in 75 %, atherosclerosis of peripheral arteries — in 33.3 %, type 2 diabetes mellitus (DM 2) — in 20 %, obesity — in 40.7 %. The proportion of smokers was 43.8 %. According to the results of laboratory studies, dyslipidemia was diagnosed in 44.7 % of patients. According to coronary angiography, 55 % of patients had no coronary artery stenosis, 21.7 % had stenosis of one artery, and stenosis of two or more arteries was defined in 23.3 % of cases. The following distribution by lesions’ types was established: irregularities in the contours of arteries or stenosis up to 30 % in 35 % of cases; stenosis ≥ 30 < 50 % in 18.3 %, and slow evacuation of the contrast agent in 16.7 % of cases. Men prevailed in our research, which is inconsistent with the data of large observational studies, probably due to a small quantity of patients. Hypertension, chronic heart failure, tobacco smoking, obesity and dyslipidemia prevailed among the basic risk factors. Patients with MINOCA require careful evaluation to determine the causative agent and appropriate treatment choices. Conduction of large‑scale studies, in particular, randomized controlled observations, is reasonable and necessary to determine the optimal tactics for management patients with MINOCA.  

scholarly journals Myocardial infarction without obstructive coronary artery disease (MINORCA)

2020 ◽  
Vol 98 (2) ◽  
pp. 89-97
Author(s):  
E. A. Safonova ◽  
I. A. Sukmanova
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Spasm ◽  
Microvascular Dysfunction ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Artery Disease ◽  
Prevention Methods

«MINOCA» (myocardial infarction with nonobstructive coronary arteries) is a new term in cardiology, which combines a different group of pathological conditions, as a result of which myocardial infarction develops with non-obstructive coronary arteries. The article reveals the etiology and pathogenesis of MINOCA, which is divided into coronarogenic: non-obstructive atherosclerosis, coronary spasm, microvascular dysfunction, coronary artery dissection, muscle bridge and not coranorogenic: myocarditis, cardiomyopathy, thrombophilia, pulmonary embolism. The issues of diagnosis and differential diagnosis attract attention, which determines the further choice of management and treatment tactics. Currently, there are no recommendations for the management and treatment of patients with a diagnosis of MINOCA; accordingly, prevention methods have not been developed. The term «MINOCA» poses a number of questions for us, many of which remain open for further discussion and resolution.

scholarly journals Myocardial infarction or acute coronary syndrome with non-obstructive coronary arteries and sudden cardiac death: a missing connection

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1303-1310
Author(s):  
Nikolaos Kosmas ◽  
Antonis S Manolis ◽  
Nikolaos Dagres ◽  
Efstathios K Iliodromitis
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
Coronary Arteries ◽  
Cardiac Death ◽  
Large Scale ◽  
Artery Dissection ◽  
Atheromatous Plaque ◽  
Coronary Syndrome

Abstract Myocardial infarction with non-obstructive coronary arteries or any acute coronary syndrome (ACS) with normal or near-normal (non-obstructive) coronary arteries (ACS-NNOCA) is an heterogeneous clinical entity, which includes different pathophysiology mechanisms and is challenging to treat. Sudden cardiac death (SCD) is a catastrophic manifestation of ACS that is crucial to prevent and treat urgently. The concurrence of the two conditions has not been adequately studied. This narrative review focuses on the existing literature concerning ACS-NNOCA pathophysiology, with an emphasis on SCD, together with risk and outcome data from clinical trials. There have been no large-scale studies to investigate the incidence of SCD within ACS-NNOCA patients, both early and late in the disease. Some pathophysiology mechanisms that are known to mediate ACS-NNOCA, such as atheromatous plaque erosion, anomalous coronary arteries, and spontaneous coronary artery dissection are documented causes of SCD. Myocardial ischaemia, inflammation, and fibrosis are probably at the core of the SCD risk in these patients. Effective treatments to reduce the relevant risk are still under research. ACS-NNOCA is generally considered as an ACS with more ‘benign’ outcome compared to ACS with obstructive coronary artery disease, but its relationship with SCD remains obscure, especially until its incidence and effective treatment are evaluated.

Prevalence, Incidence and Risk Factors of Chronic Heart Failure in the Type 2 Diabetic Population: Systematic Review

2009 ◽  
Vol 5 (3) ◽  
pp. 171-184 ◽  
Author(s):  
Linuo Zhou ◽  
Wei Deng ◽  
Lixue Zhou ◽  
Ping Fang ◽  
Daikun He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Diabetic Population ◽  
Type 2 Diabetic

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

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.

Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
S Boldueva ◽  
V Feoktistova ◽  
D Evdokimov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Atherosclerotic Plaque ◽  
St Elevation ◽  
Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.  The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

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

Circulation ◽  
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

scholarly journals Spontaneous coronary artery dissection: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

scholarly journals Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1181
Author(s):  
Paul Simion ◽  
Bogdan Artene ◽  
Ionut Achiței ◽  
Iulian Theodor Matei ◽  
Antoniu Octavian Petriș ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Myocardial Infarctions ◽  
Left Ventricular Ejection ◽  
Emergency Setting ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology.

scholarly journals Effects of SGLT2 Inhibitors beyond Glycemic Control—Focus on Myocardial SGLT1

2021 ◽  
Vol 22 (18) ◽  
pp. 9852
Author(s):  
Alex Ali Sayour ◽  
Mihály Ruppert ◽  
Attila Oláh ◽  
Kálmán Benke ◽  
Bálint András Barta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Large Scale ◽  
Sglt2 Inhibitor ◽  
Basic Research ◽  
Additional Benefit ◽  
Sglt2 Inhibitors ◽  
Preclinical Studies ◽  
Sodium Glucose Cotransporter

Selective sodium–glucose cotransporter 2 (SGLT2) inhibitors reduced the risk of hospitalization for heart failure in patients with or without type 2 diabetes (T2DM) in large-scale clinical trials. The exact mechanism of action is currently unclear. The dual SGLT1/2 inhibitor sotagliflozin not only reduced hospitalization for HF in patients with T2DM, but also lowered the risk of myocardial infarction and stroke, suggesting a possible additional benefit related to SGLT1 inhibition. In fact, several preclinical studies suggest that SGLT1 plays an important role in cardiac pathophysiological processes. In this review, our aim is to establish the clinical significance of myocardial SGLT1 inhibition through reviewing basic research studies in the context of SGLT2 inhibitor trials.

Abstract 105: Rehospitalization After Admission With Myocardial Infarction and Spontaneous Coronary Artery Dissection

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
Kevin F Kennedy ◽  
Anna Grodzinsky ◽  
Sahar Naderi ◽  
Malissa J Wood ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chest Pain ◽  
Coronary Artery ◽  
Young Patients ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Patient Factors ◽  
Factors Associated

Introduction: Spontaneous coronary artery dissection (SCAD) is one of the most common non-atherosclerotic causes of myocardial infarction (MI) in young patients, yet little is known about post-discharge outcomes. Given the high psychological stress of a SCAD diagnosis, we sought to understand the rehospitalization burden after SCAD so as to provide more prognostic data to SCAD patients. Methods: Using data from the Nationwide Readmission Database 2010-16, we identified patients 18-55 years of age hospitalized with MI with and without SCAD. We compared readmission over 1 year after index hospitalization for all-cause, MI, chest pain without MI, and heart failure. Cox proportional regression was used to examine factors associated with readmission, and we explored interactions of patient factors*SCAD to identify factors associated with differential risk of readmission in patients with SCAD. Results: Among 327,227 young patients admitted with an MI, 3704 (1.1%) had a diagnosis of SCAD. Patients with SCAD were more likely to be younger, women, have a higher burden of anxiety or depression, and longer length of stay compared with those without SCAD. While the risk of all-cause rehospitalization over 1 year was similar in those with versus without SCAD (KM-estimated rates: 22.3% vs. 24.1%; log-rank p=0.596, Figure), patients with SCAD were more likely to be rehospitalized for MI (4.9% vs. 4.2%, log-rank p=0.012) and chest pain without MI (3.6% vs. 2.8%, log-rank p=0.060) but less likely to be rehospitalized for heart failure (1.0 % vs. 1.8%, log-rank p=0.005). In the multivariable model, a diagnosis of SCAD was not associated with risk of rehospitalization (HR 1.00, 95% CI 0.92-1.08) nor was a diagnosis of SCAD associated with a differential effect of any of the patient factors on the risk of rehospitalization (all interaction p-values >0.05). Conclusion: Although patients with SCAD had a similar risk of rehospitalization compared with young patients with MI but without SCAD, we identified different patterns of hospitalization, which may be explained by the different underlying conditions. Further studies are needed to investigate possible interventions to reduce the high burden of post-SCAD rehospitalizations.

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