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Vranken NP, Pustjens TF, Kolkman E, Hermanides RS, Bekkers SC, Smulders MW, van Cauteren YJ, Heijman J, Rasoul S, Ottervanger JP, van 't Hof AW. MINOCA: The caveat of absence of coronary obstruction in myocardial infarction. IJC HEART & VASCULATURE 2020; 29:100572. [PMID: 32642553 PMCID: PMC7334364 DOI: 10.1016/j.ijcha.2020.100572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 01/10/2023]
Abstract
AIMS Whether patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) have better outcomes than patients with obstructive coronary artery disease remains contradictory. The current study focussed on the clinical profile and prognosis of MINOCA patients. METHODS AND RESULTS We performed a retrospective analysis of patients with acute coronary syndrome (ACS) admitted to the Isala hospital in Zwolle, the Netherlands, between 2006 and 2014. A total of 7693 patients were categorized into three groups: MINOCA, single-vessel obstructive ACS (SV-ACS), and multi-vessel obstructive ACS (MV-ACS). MINOCA patients (5.2% of the total population) were more likely to be female (51.5% vs. 30.3% and 26.0% in SV-ACS and MV-ACS, respectively, p < 0.001 for both). The prevalence of risk factors in the MINOCA group was in between the SV-ACS and MV-ACS groups. Logistic regression revealed a lower odds of dying in SV-ACS (odds ratio (OR) = 0.70 (p = 0.04)) and a similar odds in MV-ACS (OR = 0.88, p = 0.45) compared to MINOCA. CONCLUSIONS Patients with MINOCA show an 'intermediate' risk profile with mortality rates in between those of both ACS groups. Hence, MINOCA should be recognised as a potential risk factor for mortality, requiring adequate treatment and follow-up.
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Affiliation(s)
- Nousjka P.A. Vranken
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Evelien Kolkman
- Diagram Diagnostic Research and Management, Zwolle, the Netherlands
| | | | - Sebastiaan C.A.M. Bekkers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Martijn W. Smulders
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Yvonne J.M. van Cauteren
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Jordi Heijman
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Saman Rasoul
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | | | - Arnoud W.J. van 't Hof
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
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152
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Williams MG, Thompson C, Johnson TW, Bucciarelli-Ducci C. A Challenging and Unexpected Case of MINOCA Using Multimodality Imaging. JACC Case Rep 2020; 2:1564-1569. [PMID: 34317018 PMCID: PMC8302167 DOI: 10.1016/j.jaccas.2020.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/01/2022]
Abstract
We describe a challenging case of a patient with MINOCA due to isolated right ventricular myocardial infarction with microvascular obstruction identified on cardiac magnetic resonance imaging. This case highlights that even a comprehensive, guideline-based assessment of these patients can initially fail to detect the underlying pathology. (Level of Difficulty: Beginner.).
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Key Words
- CMR, cardiac magnetic resonance
- CRP, C-reactive protein
- CTPA, computed tomography pulmonary angiogram
- ECG, electrocardiogram
- LAD, left anterior descending
- LGE, late gadolinium enhancement
- MINOCA, myocardial infarction with nonobstructive coronary arteries
- MVO, microvascular obstruction
- OCT, optical coherence tomography
- RV, right ventricle
- cardiac magnetic resonance
- coronary angiography
- myocardial infarction
- right ventricle
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Affiliation(s)
- Matthew G.L. Williams
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Charlotte Thompson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas W. Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
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153
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Kavanagh DPJ, Lokman AB, Neag G, Colley A, Kalia N. Imaging the injured beating heart intravitally and the vasculoprotection afforded by haematopoietic stem cells. Cardiovasc Res 2020; 115:1918-1932. [PMID: 31062860 PMCID: PMC6803816 DOI: 10.1093/cvr/cvz118] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/20/2019] [Accepted: 05/01/2019] [Indexed: 12/16/2022] Open
Abstract
Aims Adequate microcirculatory perfusion, and not just opening of occluded arteries, is critical to salvage heart tissue following myocardial infarction. However, the degree of microvascular perfusion taking place is not known, limited primarily by an inability to directly image coronary microcirculation in a beating heart in vivo. Haematopoietic stem/progenitor cells (HSPCs) offer a potential therapy but little is known about their homing dynamics at a cellular level and whether they protect coronary microvessels. This study used intravital microscopy to image the anaesthetized mouse beating heart microcirculation following stabilization. Methods and results A 3D-printed stabilizer was attached to the ischaemia–reperfusion injured (IRI) beating heart. The kinetics of neutrophil, platelet and HSPC recruitment, as well as functional capillary density (FCD), was imaged post-reperfusion. Laser speckle contrast imaging (LSCI) was used for the first time to monitor ventricular blood flow in beating hearts. Sustained hyperaemic responses were measured throughout reperfusion, initially indicating adequate flow resumption. Intravital microscopy confirmed large vessel perfusion but demonstrated poor transmission of flow to downstream coronary microvessels. Significant neutrophil adhesion and microthrombus formation occurred within capillaries with the latter occluding them, resulting in patchy perfusion and reduced FCD. Interestingly, ‘patrolling’ neutrophils were also observed in capillaries. Haematopoietic stem/progenitor cells readily trafficked through the heart but local retention was poor. Despite this, remarkable anti-thromboinflammatory effects were observed, consequently improving microvascular perfusion. Conclusion We present a novel approach for imaging multiple microcirculatory perturbations in the beating heart with LSCI assessment of blood flow. Despite deceptive hyperaemic responses, increased microcirculatory flow heterogeneity was seen, with non-perfused areas interspersed with perfused areas. Microthrombi, rather than neutrophils, appeared to be the major causative factor. We further applied this technique to demonstrate local stem cell presence is not a pre-requisite to confer vasculoprotection. This is the first detailed in vivo characterization of coronary microcirculatory responses post-reperfusion injury.
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Affiliation(s)
- Dean P J Kavanagh
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Adam B Lokman
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Georgiana Neag
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Abigail Colley
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Neena Kalia
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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154
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Lamour A, Camarzana A, Gräni C, Le Roux C, Willoteaux S, Prunier F, Furber A, Bière L. Is an ischemic origin in MINOCA patients predictable? Int J Cardiovasc Imaging 2020; 36:2251-2253. [PMID: 32712735 DOI: 10.1007/s10554-020-01940-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023]
Abstract
This study sought to identify parameters that could guide towards an ischemic origin in patients hospitalized for myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is challenging in clinical practice, as the pathophysiology is multifaceted. A total of 135 patients with MINOCA who underwent cardiovascular magnetic resonance imaging (CMR) in a single tertiary University Hospital, were retrospectively included. The study cohort was classified into 4 groups according to the CMR diagnosis (i.e., myocarditis, myocardial infarction, Takotsubo cardiomyopathy, normal or uncommon diagnosis). According to the CMR, 62% had myocarditis, 14.1% myocardial infarction, 4.4% of Takotsubo and 19.3% showed a normal CMR or uncommon diagnoses. In the multivariate analysis, three criteria were independently correlated with the underlying diagnosis of myocardial infarction: (1) the absence of inflammatory response (HR: 5.71 IC95% [1.79-18.28]; p = 0.002), (2) the presence of coronary atheroma in invasive coronary angiography (HR: 6.56 IC95% [2.27-18.92]; p = 0.001) and (3) a peak of troponin ratio elevated than normal levels of 150 (HR: 4.12 IC95% [1.45-11.65]; p = 0.01). The prevalence of myocardial infarction in MINOCA was 4.9% in the absence of these three criteria, 3.4% with one of the criteria present, 34.5% with two criteria present and 71.4% with all three criteria. The negative predictive value for MI was 96% in the presence of at least two criteria. Our study shows that the absence of inflammatory response, a high troponin and the presence of angiographic coronary atheroma are independently correlated with a myocardial infarction underlying cause of MINOCA.
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Affiliation(s)
- Alban Lamour
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Cardiology, University Hospital of Angers, 49000, Angers, France
| | - Audrey Camarzana
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Cardiology, University Hospital of Angers, 49000, Angers, France
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Céleste Le Roux
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Cardiology, University Hospital of Angers, 49000, Angers, France
| | - Serge Willoteaux
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Radiology, University Hospital of Angers, 49000, Angers, France
| | - Fabrice Prunier
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Cardiology, University Hospital of Angers, 49000, Angers, France
| | - Alain Furber
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France.,Department of Cardiology, University Hospital of Angers, 49000, Angers, France
| | - Loïc Bière
- Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000, Angers, France. .,Department of Cardiology, University Hospital of Angers, 49000, Angers, France.
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155
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Burlacu A, Tinica G, Artene B, Simion P, Savuc D, Covic A. Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry. Emerg Med Int 2020; 2020:9839281. [PMID: 32765909 PMCID: PMC7387982 DOI: 10.1155/2020/9839281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/14/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background. Inappropriate cardiac catheterization lab activation together with false-positive angiographies and no-culprit found coronary interventions are now reported as costly to the medical system, influencing STEMI process efficiency. We aimed to analyze data from a high-volume interventional centre (>1000 primary PCIs/year) exploring etiologies and reporting characteristics from all "blank" coronary angiographies in STEMI. METHODS In this retrospective observational single-centre cohort study, we reported two-year data from a primary PCI registry (2035 patients). "Angio-only" cases were assigned to one of these categories: (a) Takotsubo syndrome; (b) coronary embolisation; (c) myocardial infarction with nonobstructive coronary arteries; (d) myocarditis; (e) CABG-referred; (f) normal coronary arteries (mostly diagnostic errors); and (g)others (refusals and death prior angioplasty). Univariate analysis assessed correlations between each category and cardiovascular risk factors. RESULTS 412 STEMI patients received coronary angiography "only," accounting for 20.2% of cath lab activations. Barely 77 patients had diagnostic errors (3.8% from all patients) implying false-activations. 40% of "angio-only" patients (n = 165) were referred to surgery due to severe atherosclerosis or mechanical complications. Patients with diagnostic errors and normal arteries displayed strong correlations with all cardiovascular risk factors. Probably, numerous risk factors "convinced" emergency department staff to call for an angio. CONCLUSIONS STEMI network professionals often confront with coronary angiography "only" situations. We propose a classification according to etiologies. Next, STEMI guidelines should include audit recommendations and specific thresholds regarding "angio-only" patients, with specific focus on MINOCA, CABG referrals, and diagnostic errors. These measures will have a double impact: a better management of the patient, and a clearer perception about the usefulness of the investments.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Grigore Tinica
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Bogdan Artene
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Paul Simion
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Diana Savuc
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, Iasi, Romania
- "Grigore T. Popa" University of Medicine, Iasi, Romania
- The Academy of Romanian Scientists (AOSR), Bucharest, Romania
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156
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Gu XH, He CJ, Shen L, Han B. Association Between Depression and Outcomes in Chinese Patients With Myocardial Infarction and Nonobstructive Coronary Arteries. J Am Heart Assoc 2020; 8:e011180. [PMID: 30803294 PMCID: PMC6474919 DOI: 10.1161/jaha.118.011180] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Myocardial infarction with nonobstructive coronary arteries ( MINOCA ) occurs in ≈10% of all patients with myocardial infarction. Studies on effects of depression on MINOCA outcomes are lacking. Therefore, the aim of this study was to examine the association of depression with clinical outcomes in Chinese patients with MINOCA . Methods and Results We conducted a prospective cohort study of 633 participants with MINOCA and followed up for 3 years. End points were defined as all-cause mortality and cardiovascular events. Diagnosis of depression was ascertained using the psychiatric interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). During the follow-up period, all-cause death occurred in 93 individuals and cardiovascular events developed in 170 individuals. Kaplan-Meier curves showed a significant association of depression with all-cause mortality (log-rank P<0.001) and cardiovascular events (log-rank P<0.001). Multiple Cox regression identified the new diagnosis of depression as an independent prognostic factor for all-cause mortality as well as cardiovascular events (adjusted hazard ratio, 7.250; 95% CI, 4.735-11.100; P<0.001; and hazard ratio, 3.411; 95% CI , 2.490-4.674; P<0.001, respectively). Conclusions The new diagnosis of depression at the time of myocardial infarction is associated with increased risk of adverse clinical outcomes in patients with MINOCA.
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Affiliation(s)
- Xiao-Hong Gu
- 1 Department of Infectious Diseases and Department of Nursing First Affiliated Hospital of Jiaxing University Jiaxing Zhejiang China
| | - Chao-Jie He
- 2 Department of Cardiology First Affiliated Hospital of Jiaxing University Jiaxing Zhejiang China
| | - Liang Shen
- 2 Department of Cardiology First Affiliated Hospital of Jiaxing University Jiaxing Zhejiang China
| | - Bin Han
- 3 Department of Nephrology First Affiliated Hospital of Jiaxing University Jiaxing Zhejiang China
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157
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Vágó H, Szabó L, Dohy Z, Czimbalmos C, Tóth A, Suhai FI, Bárczi G, Gyarmathy VA, Becker D, Merkely B. Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries. Heart 2020; 106:992-1000. [PMID: 32447308 PMCID: PMC7306881 DOI: 10.1136/heartjnl-2019-316295] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries. METHODS In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out. RESULTS CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality. CONCLUSIONS CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
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Affiliation(s)
- Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - György Bárczi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - V Anna Gyarmathy
- EpiConsult LLC, Dover, Delaware, USA
- Johns Hopkins, Baltimore, Maryland, USA
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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158
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Gatti M, Carisio A, D'Angelo T, Darvizeh F, Dell'Aversana S, Tore D, Centonze M, Faletti R. Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: A review. World J Cardiol 2020; 12:248-261. [PMID: 32774777 PMCID: PMC7383353 DOI: 10.4330/wjc.v12.i6.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) necessitates documentation of an acute myocardial infarction (AMI), non-obstructive coronary arteries, using invasive coronary angiography or coronary computed tomography angiography and no clinically overt cause for AMI. Historically patients with MINOCA represent a clinical dilemma with subsequent uncertain clinical management. Differential diagnosis is crucial to choose the best therapeutic option for ischemic and non-ischemic MINOCA patients. Cardiovascular magnetic resonance (CMR) is able to analyze cardiac structure and function simultaneously and provides tissue characterization. Moreover, CMR could identify the cause of MINOCA in nearly two-third of patients providing valuable information for clinical decision making. Finally, it allows stratification of patients with worse outcomes which resulted in therapeutic changes in almost half of the patients. In this review we discuss the features of CMR in MINOCA; from exam protocols to imaging findings.
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Affiliation(s)
- Marco Gatti
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy.
| | - Andrea Carisio
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina 98100, Italy
| | - Fatemeh Darvizeh
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Serena Dell'Aversana
- Department of advanced biomedical sciences, University of Naples Federico II, Naples 80138, Italy
| | - Davide Tore
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Maurizio Centonze
- Department of Diagnostic Imaging, APSS di Trento, Trento 38123, Italy
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159
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Y-Hassan S. Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction. World J Cardiol 2020; 12:231-247. [PMID: 32774776 PMCID: PMC7383352 DOI: 10.4330/wjc.v12.i6.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm S-141 86, Sweden
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160
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Barsky L, Merz CNB, Wei J, Shufelt C, Handberg E, Pepine C, Rutledge T, Reis S, Doyle M, Rogers W, Shaw L, Sopko G. Even "WISE-R?"-an Update on the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation. Curr Atheroscler Rep 2020; 22:35. [PMID: 32556630 PMCID: PMC7388776 DOI: 10.1007/s11883-020-00852-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW For over 20 years, the Women's Ischemia Syndrome Evaluation (WISE), a program sponsored by the National Heart, Lung, and Blood Institute, has explored diverse and important aspects of ischemic heart disease in women. RECENT FINDINGS Women with symptoms and signs of ischemia but no significant epicardial obstructive coronary artery disease (INOCA) were documented to be at elevated risk for recurrent angina hospitalization, major adverse cardiac events, death, and health resource consumption rivaling those with obstructive coronary disease. WISE investigators have advanced our understanding of cardiovascular outcomes, systemic manifestations, psychological variables, socioeconomic factors, genetic contributions, hormonal status, advanced imaging, coronary functional findings, biomarkers, patient-reported outcomes, and treatments pertaining to women with this disease entity. This review delves into the WISE findings subsequent to a prior review1, postulates directions for future research, and asks are we "Even 'WISE-R?'".
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Affiliation(s)
- Lili Barsky
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA.
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA, 90048, USA
| | - Eileen Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Carl Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas Rutledge
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego, CA, USA
| | - Steven Reis
- Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Doyle
- Division of Cardiology, Department of Medicine, Allegheny University of the Health Sciences, Pittsburgh, PA, USA
| | - William Rogers
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leslee Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography. PLoS One 2020; 15:e0234735. [PMID: 32544195 PMCID: PMC7297353 DOI: 10.1371/journal.pone.0234735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background With the emerging interest in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), there is a need to define an even broader group of patients with the syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA). There are limited data on the clinical characteristics and prognoses of such patients who present with symptoms of acute coronary syndrome (ACS) and undergo urgent coronary angiography that reveals no significant lesions. The aim of this observational study was to compare patients with ACS INOCA and those with ACS with obstructive coronary artery disease (OCAD) both within unadjusted cohorts and with propensity score matched controls. Methods and results This observational study was based on the data from the Polish National Registry of Invasive Cardiology Procedures. Of 9744 patients included, 7624 had OCAD and 2120 had ACS INOCA. In unadjusted cohorts, the overall survival and incidence of major adverse cardiovascular events (MACE: death, cardiac arrest, myocardial infarction, stroke, and heart failure hospitalization) until 36 months were higher in patients with ACS OCAD. Following propensity matching, higher win ratios of death (p = 0.02), additional revascularizations by percutaneous coronary intervention or coronary artery bypass graft surgery (p<0.001), and cardiac hospitalization (p<0.001) were observed in these patients. In contrast, the win ratios of myocardial infarction (p = 0.74), heart failure hospitalization (p = 0.86), and MACE (p = 0.07) were not significantly different between the groups. Conclusions The prognosis of patients with ACS INOCA was more favorable than that of patients with ACS OCAD; however, the differences diminished after adjustments for the initial clinical profiles. An ACS incident should not be judged as trivial even when cardiac markers remain stable and no significant lesions are found on angiography.
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162
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He CJ, Zhu CY, Han B, Hu HZ, Wang SJ, Zhai CL, Hu HL. Association between anxiety and clinical outcomes in Chinese patients with myocardial infarction in the absence of obstructive coronary artery disease. Clin Cardiol 2020; 43:659-665. [PMID: 32515510 PMCID: PMC7368297 DOI: 10.1002/clc.23386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) accounts for approximately 5% - 6% of acute myocardial infarction (AMI) patients. Anxiety symptoms are common in patients with coronary artery disease (CAD), and are associated with a poor prognosis. However, the association between anxiety and MINOCA outcomes is less clear. HYPOTHESIS Anxiety will be associated with clinical outcomes in patients with MINOCA. METHODS AND RESULTS Between November 2014 and December 2016, 620 hospitalized patients with MINOCA were recruited from a single center. Within 7 days of coronary angiography, anxiety was assessed using the Zung Self-Rating Anxiety Scale. The primary endpoint was all-cause mortality; secondary endpoint was any major adverse cardiovascular event (MACE). After 3 years, 87 deaths and 151 MACE had occurred. Kaplan-Meier curves indicated the unadjusted rates of all-cause mortality (log-rank P = .045) and MACE (log-rank P = .023) were significantly higher in the anxiety group compared with the control group of patients without anxiety. Multivariate Cox regression analysis showed that clinically significant anxiety was an independent prognostic factor for all-cause mortality as well as MACE (hazard ratio [HR] = 1.547; 95% confidence interval [CI], 1.006-2.380; P = .047; HR = 1.460; 95% CI, 1.049-2.031; P = .025; respectively). CONCLUSIONS Anxiety is significantly and independently associated with an increased risk of all-cause mortality and MACE in patients with MINOCA.
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Affiliation(s)
- Chao-Jie He
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chun-Yan Zhu
- Department of Psychology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Bin Han
- Department of Nephrology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hai-Zhen Hu
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Shi-Jun Wang
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chang-Lin Zhai
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hui-Lin Hu
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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163
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Abstract
Emergence of various highly sensitive cardiac troponin assays into clinical practice provides a new tool for clinicians diagnosing acute coronary syndrome. These assays also create a challenge for laboratories and clinicians who have yet to familiarize themselves with sex-specific cutoffs. Healthy men and women, studied across various age groups and geographic locations, have notable differences in baseline values of highly sensitive cardiac troponin I and T, leading to establishment of sex-specific upper reference limits and cutoffs. Several differences in cardiac physiology, size, and structure may account for baseline differences in highly sensitive cardiac troponins and outcomes between the sexes. The clinical utility of implementing sex-specific cutoffs for diagnosis and management of acute coronary syndrome remains unclear. Presently, the only prospective study failed to show improved outcomes for men or women with use of sex-specific cutoffs; however, a major limitation is the frequent lack of diagnostic, therapeutic, and preventive interventions prescribed to women with low-level troponin elevations. Based on the current literature, we posit that there may nonetheless be clinical value in the use of sex-specific cutoffs for evaluating suspected acute coronary syndrome, especially in select patient populations such as younger women who tend to have lower baseline values of highly sensitive cardiac troponins. Future studies should prospectively evaluate differences in diagnostic, pharmacologic, and interventional management in men and women using myocardial infarctions classified with sex-specific cutoffs of the highly sensitive cardiac troponin assays.
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Affiliation(s)
- Prerana M. Bhatia
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of CaliforniaSan Diego
| | - Lori B. Daniels
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of CaliforniaSan Diego
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164
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Matta A, Bouisset F, Lhermusier T, Campelo-Parada F, Elbaz M, Carrié D, Roncalli J. Coronary Artery Spasm: New Insights. J Interv Cardiol 2020; 2020:5894586. [PMID: 32508542 PMCID: PMC7245659 DOI: 10.1155/2020/5894586] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/27/2020] [Accepted: 04/18/2020] [Indexed: 12/30/2022] Open
Abstract
Coronary artery spasm (CAS) defined by a severe reversible diffuse or focal vasoconstriction is the most common diagnosis among INOCA (ischemia with no obstructive coronary artery disease) patients irrespective to racial, genetic, and geographic variations. However, the prevalence of CAS tends to decrease in correlation with the increasing use of medicines such as calcium channel blockers, angiotensin converting enzyme inhibitor, and statins, the controlling management of atherosclerotic risk factors, and the decreased habitude to perform a functional reactivity test in highly active cardiac catheterization centers. A wide spectrum of clinical manifestations from silent disease to sudden cardiac death was attributed to this complex entity with unclear pathophysiology. Multiple mechanisms such as the autonomic nervous system, endothelial dysfunction, chronic inflammation, oxidative stress, and smooth muscle hypercontractility are involved. Regardless of the limited benefits proffered by the newly emerged cardiac imaging modalities, the provocative test remains the cornerstone diagnostic tool for CAS. It allows to reproduce CAS and to evaluate reactivity to nitrates. Different invasive and noninvasive therapeutic approaches are approved for the management of CAS. Long-acting nondihydropyridine calcium channel blockers are recommended for first line therapy. Invasive strategies such as PCI (percutaneous coronary intervention) and CABG (coronary artery bypass graft) have shown benefits in CAS with significant atherosclerotic lesions. Combination therapies are proposed for refractory cases.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Frederic Bouisset
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Thibault Lhermusier
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Fran Campelo-Parada
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
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165
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Boumaaz M, Asfalou I, Hamami A, Raissouni M, Lakhal Z, Benyass A. Myocardial Infarction Caused by an Enclosed Thrombus in a Patent Foramen Ovale. J Saudi Heart Assoc 2020; 32:204-207. [PMID: 33154917 PMCID: PMC7640573 DOI: 10.37616/2212-5043.1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive » based on certain criteria. It can be considered "proven" when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly trans-esophageal echocardiography, especially if performed soon after presentation, for early diagnosis.
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Affiliation(s)
- Meriem Boumaaz
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Iliyasse Asfalou
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Amine Hamami
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Maha Raissouni
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Zouhair Lakhal
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Aatif Benyass
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
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166
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Sherashov AV, Shilova AS, Pershina ES, Shchekochikhin DY, Svet AV, Gilyarov MY. [Myocardial infarction with nonobstructive coronary arteries]. ACTA ACUST UNITED AC 2020; 60:89-95. [PMID: 32375620 DOI: 10.18087/cardio.2020.3.n881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
The review focused on a relatively new issue, myocardial infarction with non-obstructive coronary arteries (MINOCA). According to current ideas, almost 6% of all myocardial infarction (MI) cases may be MINOCA. This term can be used both as a "working diagnosis" at the time of further evaluation and a final diagnosis after establishing a cause for each specific case. Since some variants of cardiac, including non-coronary, pathology may be similar to MI in a number of signs, each individual case of MINOCA requires specification. Among major causes for this condition are vasospasm, CA embolism, spontaneous CA dissection, rupture of an eccentric atherosclerotic plaque in a CA, etc. Diagnostics of MINOCA includes both a set of diagnostic tests for verification of the MI diagnosis according to the Fourth Universal Definition of MI and specific studies for elaboration of the disease etiology. A special role in differential diagnostics belongs to gadolinium-enhanced magnetic-resonance imaging (MRI) of the myocardium, which allows to distinguish between MI and non-ischemic myocardial injury of different genesis. Methods of intravascular visualization, such as optical coherence tomography (OCT) and intravascular ultrasound are also important. Commonly accepted guidelines on the treatment of this pathology consistent with current ideas are not available. However, it is obvious that therapeutic possibilities and prognosis for MINOCA depend on the identified cause in each individual case.
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Affiliation(s)
| | - A S Shilova
- City clinical hospital #1 named after N. I. Pirogov
| | - E S Pershina
- City clinical hospital #1 named after N. I. Pirogov
| | - D Yu Shchekochikhin
- City clinical hospital #1 named after N. I. Pirogov First Moscow State Medical University named after I. M. Sechenov
| | - A V Svet
- City clinical hospital #1 named after N. I. Pirogov
| | - M Yu Gilyarov
- Russian National Research Medical Univercity named after N. I. Pirogov City clinical hospital #1 named after N. I. Pirogov
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167
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Graça Santos L, Ribeiro Carvalho R, Montenegro Sá F, Soares F, Pernencar S, Castro R, Morais J. Circulating Heterophile Antibodies Causing Cardiac Troponin Elevation: An Unusual Differential Diagnosis of Myocardial Disease. JACC Case Rep 2020; 2:456-460. [PMID: 34317263 PMCID: PMC8311687 DOI: 10.1016/j.jaccas.2020.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/24/2023]
Abstract
We present the case of a female patient who developed persistently elevated levels of cardiac troponin (cTn) after a previous episode of clinically presumed myocarditis. Extensive investigation concluded that the presence of heterophile antibodies was causing false positive cTn elevation. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | | | - Francisco Soares
- Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal
| | | | - Ricardo Castro
- Department of Clinical Pathology, Leiria Hospital Centre, Leiria, Portugal
| | - João Morais
- Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal
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168
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Miyake R, Ohtani K, Hashimoto T, Yada R, Sato T, Shojima Y, Hayashidani S, Higo T, Tsutsui H. Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation. ESC Heart Fail 2020; 7:1145-1149. [PMID: 32154667 PMCID: PMC7261543 DOI: 10.1002/ehf2.12632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/06/2022] Open
Abstract
Takotsubo syndrome (TTS), also referred to as stress cardiomyopathy, is characterized by transient left ventricular apical ballooning in the absence of obstructive coronary artery disease. Catecholamine-induced cardiac injury or vasospasm has been implicated in this pathophysiology. We present a case of a 67-year-old man 10 years after heart transplantation diagnosed with TTS. Sympathetic reinnervation could not be detected by iodine-123 meta iodobenzylguanidine uptake, suggesting that TTS can occur in the absence of functional sympathetic nerve systems reconstruction.
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Affiliation(s)
- Ryo Miyake
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ryoko Yada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tasuku Sato
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoko Shojima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shunji Hayashidani
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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169
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Abstract
Historical data indicate that approximately 10% of acute coronary syndrome patients have no obstructive coronary artery disease (CAD) but contemporary incidence of non-obstructed coronary arteries in ST-segment elevation myocardial infarction (STEMI) is not clear. We aimed both to identify the contemporary incidence of MI without obstructive CAD (MINOCA)-using the ESC definition-and assess clinical outcomes. We assessed consecutive unselected STEMI patients presenting to the cardiac catheterisation laboratory with a view to undergoing primary percutaneous coronary intervention (PPCI). MINOCA was defined according to ESC criteria. Electronic patient records, blood results, angiographic and echocardiographic data were interrogated to determine final diagnosis, as well as 30-day and 1-year mortality rate. Of 2521 patients with full electronic dataset, 2158 (85.6%) underwent PPCI for obstructive CAD (angiographic stenosis > 70%). A further 167 (6.6%) with obstructive CAD were treated medically or surgically. The remaining 196 (7.8%) patients had absence of obstructive CAD at angiography, of whom 167 had no stenosis (< 30%) and 29 had mild coronary atheroma (stenosis > 30% but < 50%). A total of 110 (4.4%) patients met diagnostic criteria for MINOCA. All-cause mortality at 30-days and 1-year were 3.6% and 4.5%, respectively. In our cohort, 1 in 20 patients presenting with STEMI had MINOCA. This is the first description of the relatively high incidence of MINOCA in a STEMI cohort using current ESC definition and diagnostic criteria and could help power future trials in this area. Mortality rate was relatively high in our study and similar to that in large meta-analyses.
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170
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Berry C, Duncker DJ. Coronary microvascular disease: the next frontier for Cardiovascular Research. Cardiovasc Res 2020; 116:737-740. [PMID: 32149331 PMCID: PMC7061275 DOI: 10.1093/cvr/cvaa035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research School COEUR, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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171
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Pustjens TFS, Appelman Y, Damman P, Ten Berg JM, Jukema JW, de Winter RJ, Agema WRP, van der Wielen MLJ, Arslan F, Rasoul S, van 't Hof AWJ. Guidelines for the management of myocardial infarction/injury with non-obstructive coronary arteries (MINOCA): a position paper from the Dutch ACS working group. Neth Heart J 2020; 28:116-130. [PMID: 31758492 PMCID: PMC7052103 DOI: 10.1007/s12471-019-01344-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA), defined as angiographic stenosis <50%, represent a conundrum given the many potential underlying aetiologies. Possible causes of MINOCA can be subdivided into coronary, myocardial and non-cardiac disorders. MINOCA is found in up to 14% of patients presenting with an acute coronary syndrome. Clinical outcomes including mortality, and functional and psychosocial status, are comparable to those of patients with myocardial infarction and obstructive coronary arteries. However, many uncertainties remain regarding the definition, clinical features and management of these patients. This position paper of the Dutch ACS working group of the Netherlands Society of Cardiology aims to stress the importance of considering MINOCA as a dynamic working diagnosis and to guide the clinician in the management of patients with MINOCA by proposing a clinical diagnostic algorithm.
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Affiliation(s)
- T F S Pustjens
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Y Appelman
- Department of Cardiology, location VU University Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R J de Winter
- Department of Cardiology, location Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - W R P Agema
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L J van der Wielen
- Department of Cardiology, location Bethesda, Treant Zorggroep, Hoogeveen, The Netherlands
| | - F Arslan
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - S Rasoul
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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172
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Albenque G, Bohbot Y, Delpierre Q, Tribouilloy C. Basal Takotsubo syndrome with transient severe mitral regurgitation caused by drug use: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32864562 PMCID: PMC7446733 DOI: 10.1093/ehjcr/ytaa028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/18/2019] [Accepted: 01/23/2020] [Indexed: 01/27/2023]
Abstract
Background Takotsubo syndrome (TTS) is a reversible cardiomyopathy. Little is known regarding its basal form and possible complications. Case summary A 31-year-old woman with no medical history was hospitalized for attempted suicide by ingestion of cocaine, benzodiazepine, and methadone. Initially, the patient received intensive care for coma and bradypnoea. After naloxone administration, the neurological situation improved, but the patient developed acute pulmonary oedema. Transthoracic echocardiography (TTE) revealed left ventricular systolic dysfunction with the basal wall’s akinesia associated with moderate to severe restrictive mitral regurgitation. Global longitudinal strain (GLS) was impaired mainly in the basal segments. A coronary computed tomography ruled out coronary artery disease. Symptoms improved quickly under diuretic treatment. Transthoracic echocardiography at Day 6 showed improved basal wall contraction, with a left ventricular ejection fraction (LVEF) of 50% and moderate mitral regurgitation. TTE at Day 30 confirmed the diagnosis of myocardial infarction with non-obstructive coronary arteries related to a basal TTS after complete recovery of the LVEF, normalization of the wall motion and GLS, and the absence of residual mitral regurgitation. Discussion We report a case of acute pulmonary oedema due to basal TTS complicated by severe transient mitral regurgitation associated with moderate left ventricular dysfunction. Measuring strain by speckle-tracking can be useful to diagnose and monitor this entity. The use of coronary computed tomography is informative in young patients to rule-out coronary artery disease.
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Affiliation(s)
- Grégoire Albenque
- Department of Cardiology, Amiens University Hospital, Avenue René Laënnec, 80054 Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Avenue René Laënnec, 80054 Amiens, France.,UR UPJV 7517, CURS-UFR de pharmacie, Laboratoire UPJCV, Universite´ de Picardie, 1 chemin du Thil, 80000 Amiens, France
| | - Quentin Delpierre
- Department of Cardiology, Amiens University Hospital, Avenue René Laënnec, 80054 Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Avenue René Laënnec, 80054 Amiens, France.,UR UPJV 7517, CURS-UFR de pharmacie, Laboratoire UPJCV, Universite´ de Picardie, 1 chemin du Thil, 80000 Amiens, France
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173
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Dreyer RP, Tavella R, Curtis JP, Wang Y, Pauspathy S, Messenger J, Rumsfeld JS, Maddox TM, Krumholz HM, Spertus JA, Beltrame JF. Myocardial infarction with non-obstructive coronary arteries as compared with myocardial infarction and obstructive coronary disease: outcomes in a Medicare population. Eur Heart J 2020; 41:870-878. [PMID: 31222249 PMCID: PMC7778433 DOI: 10.1093/eurheartj/ehz403] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/29/2019] [Accepted: 05/24/2019] [Indexed: 01/05/2023] Open
Abstract
AIMS The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). METHODS AND RESULTS Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with ≥50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P < 0.001), but was similar between MINOCA and MICAD patients for re-hospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. CONCLUSION This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut, USA
- Department of Emergency, Yale School of Medicine, 464 Congress Ave, Suite 260, New Haven, Connecticut, 06510, USA
| | - Rosanna Tavella
- The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, 28 Woodville Road, Woodville South, 5011, South Australia
- Basil Hetzel Institute for Translational Research, 37 Woodville Road, Woodville South, 5011, South Australia
- Cardiology Department, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, 5011, South Australia
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, New Haven, 06520-8056, Connecticut, USA
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, New Haven, 06520-8056, Connecticut, USA
| | - Sivabaskari Pauspathy
- The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, 28 Woodville Road, Woodville South, 5011, South Australia
- Basil Hetzel Institute for Translational Research, 37 Woodville Road, Woodville South, 5011, South Australia
- Cardiology Department, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, 5011, South Australia
| | - John Messenger
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, Colorado, 80045, USA
| | - John S Rumsfeld
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, Colorado, 80045, USA
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine; 660 S Euclid Ave, St Louis, Missouri, 63110, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, New Haven, 06520-8056, Connecticut, USA
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06510, Connecticut, USA
| | - John A Spertus
- Health Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, Missouri, 64111, USA
| | - John F Beltrame
- The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, 28 Woodville Road, Woodville South, 5011, South Australia
- Basil Hetzel Institute for Translational Research, 37 Woodville Road, Woodville South, 5011, South Australia
- Cardiology Department, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, 5011, South Australia
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Kılıç S, Aydın G, Çoner A, Doğan YK, Özlük ÖA, Çelik Y, Ünğan İ, Taşcanov M, Düz R, Polat V, Özkan H, Özyaşar M, Tülüce K, Kurt D, Çetin N, Gül M, İnci S, Çoşkun FY, Arı H, Zoghi M, Ergene O, Türk UÖ. Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study. Anatol J Cardiol 2020; 23:176-182. [PMID: 32120362 PMCID: PMC7222639 DOI: 10.14744/anatoljcardiol.2019.46805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population. METHODS MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded. RESULTS A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001). CONCLUSION The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Health Sciences University Adana Training and Research Center; Adana-Turkey
| | - Gökhan Aydın
- Department of Cardiology, Health Sciences University Balıkesir Training and Research Center; Balıkesir-Turkey
| | - Ali Çoner
- Department of Cardiology, Başkent University Alanya Training and Research Center; Antalya-Turkey
| | - Yasemin Kılavuz Doğan
- Department of Cardiology, Health Sciences University Kayseri Health Practices and Research Center; Kayseri- Turkey
| | - Özlem Arıcan Özlük
- Department of Cardiology, Bursa İhtisas Training and Research Hospital; Bursa-Turkey
| | - Yunus Çelik
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital; Kırıkkale-Turkey
| | - İsmail Ünğan
- Department of Cardiology, Yalova State Hospital; Yalova-Turkey
| | - Mustafa Taşcanov
- Department of Cardiology, Tokat Medical Park Hospital; Tokat-Turkey
| | - Ramazan Düz
- Department of Cardiology, Van Training and Research Hospital; Van-Turkey
| | - Veli Polat
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital; İstanbul-Turkey
| | - Hakan Özkan
- Department of Cardiology, Bursa Medical Park Hospital; Bursa-Turkey
| | - Mehmet Özyaşar
- Department of Cardiology, Karaman State Hospital; Karaman-Turkey
| | - Kamil Tülüce
- Department of Cardiology, Çiğli Regional Training Hospital; İzmir-Turkey
| | - Devrim Kurt
- Department of Cardiology, Giresun University Prof. Dr. A. İlhan Özdemir Training and Research Hospital; Giresun-Turkey
| | - Nurullah Çetin
- Department of Cardiology, Çiğli Regional Training Hospital; İzmir-Turkey
| | - Murat Gül
- Department of Cardiology, Aksaray University Training and Research Hospital; Aksaray-Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital; Aksaray-Turkey
| | - Fatma Yılmaz Çoşkun
- Department of Cardiology, Faculty of Medicine, Gaziantep University; Gaziantep-Turkey
| | - Hasan Arı
- Department of Cardiology, Bursa İhtisas Training and Research Hospital; Bursa-Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey
| | - Oktay Ergene
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Uğur Önsel Türk
- Department of Cardiology, Cardiology KardiyoRitm Heart Center; İzmir-Turkey
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Gue YX, Kanji R, Gati S, Gorog DA. MI with Non-obstructive Coronary Artery Presenting with STEMI: A Review of Incidence, Aetiology, Assessment and Treatment. Eur Cardiol 2020; 15:e20. [PMID: 32419851 PMCID: PMC7215489 DOI: 10.15420/ecr.2019.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
MI with non-obstructive coronary artery (MINOCA) is a condition previously thought to be benign that has recently been shown to have comparable mortality to that of acute coronary syndrome with obstructive coronary disease. The heterogeneity of the underlying aetiology makes the assessment, investigation and treatment of patients with MINOCA challenging. The majority of patients with MINOCA presenting with ST-segment elevation MI generally have an underlying coronary or myocardial cause, predominantly plaque disruption or myocarditis. In order to make the correct diagnosis, in addition to the cause of the presentation, a meticulous and methodical approach is required, with targeted investigations. Stratification of patients to guide investigations that are more likely to provide the diagnosis will allow the correct treatment to be initiated promptly. In this article, the authors review the contemporary incidence, aetiology, recommended assessment and treatment of patients with MINOCA presenting with ST-segment elevation MI.
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Affiliation(s)
- Ying X Gue
- University of Hertfordshire Hertfordshire, UK
| | - Rahim Kanji
- National Heart and Lung Institute, Imperial College London, UK
| | - Sabiha Gati
- University of Hertfordshire Hertfordshire, UK
| | - Diana A Gorog
- University of Hertfordshire Hertfordshire, UK
- National Heart and Lung Institute, Imperial College London, UK
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Garcia-Guimarães M, Bastante T, Antuña P, Jimenez C, de la Cuerda F, Cuesta J, Rivero F, Premawardhana D, Adlam D, Alfonso F. Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management. Eur Cardiol 2020; 15:1-8. [PMID: 32256714 PMCID: PMC7113739 DOI: 10.15420/ecr.2019.01] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome that usually affects young to middle-aged women. Mainly because of its low prevalence, until recently, most of the evidence on this condition was derived from case reports and small series. Over the last 5 years, more robust evidence has become available from larger retrospective and prospective cohorts of patients with SCAD. The increase in knowledge and recognition of this entity has led to the publication of expert consensus on both sides of the Atlantic. However, new data are continuously accumulating from larger cohorts of patients with SCAD, bringing new light to this little-understood condition. The aim of this article is to update the knowledge on SCAD, including new information from recent studies published since the consensus documents from the European Society of Cardiology and the American Heart Association.
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Affiliation(s)
- Marcos Garcia-Guimarães
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Glenfield General Hospital, Leicester, UK
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paula Antuña
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - César Jimenez
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco de la Cuerda
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Cuesta
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - David Adlam
- Cardiology Department, Glenfield General Hospital, Leicester, UK
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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The Authors Reply:. JACC Cardiovasc Imaging 2020; 13:531. [DOI: 10.1016/j.jcmg.2019.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/24/2022]
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Paolisso P, Bergamaschi L, Saturi G, D'Angelo EC, Magnani I, Toniolo S, Stefanizzi A, Rinaldi A, Bartoli L, Angeli F, Donati F, Rucci P, Mattioli AV, Taglieri N, Pizzi C, Galiè N. Secondary Prevention Medical Therapy and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Artery Disease. Front Pharmacol 2020; 10:1606. [PMID: 32082147 PMCID: PMC7005107 DOI: 10.3389/fphar.2019.01606] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with relevant long-term major cardiovascular events. Several trials have demonstrated that dual antiplatelet therapy (DAPT), β-blocker, renin-angiotensin-aldosterone system (RAAS) inhibitor and statin therapy improve the prognosis in patients with obstructive myocardial infarction (ob-MI). However, evidence on the best medical therapy for secondary prevention in MINOCA patients is lacking. PURPOSE To investigate the effects of secondary prevention treatments at discharge on mid-term outcomes in MINOCA. METHODS Patients with acute myocardial infarction (MI) undergoing early coronary angiography between 2016 and 2018 were extracted from a clinical database. The diagnosis of MINOCA was made according to 2016 ESC MINOCA Position Paper criteria. Second-level diagnostic work-up including cardiac magnetic resonance was performed to exclude non-ischemic troponin elevation cause. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models. All confirmed MINOCA were followed in our outpatient clinics. The primary end-points were all-cause mortality, re-hospitalization for MI and a composite outcome including all-cause mortality, hospitalization for MI and ischemic stroke (MACE). RESULTS Out of 1,141 AMI who underwent coronary angiography, 134 were initially diagnosed as MINOCA. Patients with MINOCA were less likely to receive secondary prevention treatments than patients with obstructive coronary artery disease (CAD) MI (respectively, 42.1% vs 81.8% for DAPT; 75.5% vs 89.6% for β-blockers; 64.7% vs 80.3% for RAAS inhibitor and 63.9% vs 83% for statins). Based on the diagnostic work-up completed during the first month after discharge, a final sample of 88 patients had confirmed MINOCA. During an average follow-up of 19.35 ± 10.65 months, all-cause mortality occurred in 11 (12.5%) patients, recurrence of MI in 4 (4.5%), and MACE in 15 (17.0%) patients. Patients treated with RAAS inhibitors and statins had a significantly longer survival. On the contrary, no increase in survival was found in patients treated with β-blockers or DAPT. Cox multivariable analysis, including all secondary prevention drugs, showed that only RAAS inhibitors were associated with reduced all cause-mortality and MACE. CONCLUSION This prospective study suggests that RAAS inhibitor therapy provides mid-term beneficial effects on outcomes in MINOCA patients; in contrast, dual antiplatelet, β-blocker and statin therapy had no effects on mortality and MACE. These results should be considered preliminary and warrant confirmation from larger studies.
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Affiliation(s)
- Pasquale Paolisso
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Giulia Saturi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Emanuela Concetta D'Angelo
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Ilenia Magnani
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Sebastiano Toniolo
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Francesco Donati
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Anna Vittoria Mattioli
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nevio Taglieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
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Hoang TH, Lazarev PV, Maiskov VV, Meray AI, Kobalava ZD. Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2019-15-6-881-891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is diagnosed in the absence of anatomically significant stenoses (<50% of lumen diameter) on coronary angiography and characterized by heterogeneity of etiologic factors. Recently, the mechanisms of MINOCA as well as the performance of diagnostic algorithms and therapeutic strategies have been extensively studied. The purpose of this review is to reflect the current concepts regarding the etiology and pathogenesis of MINOCA, diagnostic work-up methods and individualized treatment approaches. The article covers contemporary epidemiologic data, demographic and clinical patients’ characteristics and principal causes of MINOCA. We discuss aspects of disease definition and classification of related conditions involving troponin increase in the presence of normal coronary arteries. The importance of management strategy personalization for individual patients is stressed alongside stratification of risks of recurrent cardiovascular events. This review reflects key points from international consensus statements published by leading experts and suggests promising directions for future research.
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Affiliation(s)
- T. H. Hoang
- Peoples Friendship University of Russia (RUDN University)
| | - P. V. Lazarev
- Peoples Friendship University of Russia (RUDN University)
| | - V. V. Maiskov
- Peoples Friendship University of Russia (RUDN University);
Pirogov Russian National Research Medical University;
Vinogradov City Clinical Hospital
| | - A. I. Meray
- Peoples Friendship University of Russia (RUDN University);
Vinogradov City Clinical Hospital
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181
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Mihajlović D, Maksimović Ž, Dojčinović B, Banjac N. Acute coronary syndrome (STEMI, NSTEMI and unstable angina pectoris) and risk factors, similarities and differences. SCRIPTA MEDICA 2020. [DOI: 10.5937/scriptamed51-27722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: Acute coronary syndrome (ACS) is one of the m ost common and most dramatic manifestations of ischaemic h eart disease and distinguishing of ACS from non-cardiac chest pain represents a diagnostic challenge. Objective: Determine the frequency of ACS types: NSTEMI, STEMI and unstable angina pectoris (UAP) and examine the frequency and significance of risk factors and cardiospecific enzymes in patients with ACS. Methods: The analysis included patients who were referred from the prehospital level of the Banja Luka Primary Healthcare Centre (Emergency Department and Family Medicine Department) and treated under the ACS diagnosis in the coronary unit of the Cardiovascular Diseases Clinic of the Banja Luka University Clinical Centre of the Republic of Srpska (UCCRS) in the first 6 months of 2011. The study included patients older than 18, with recorded information on their gender, age, smoking status, hypertension, diabetes, obesity and family burden. Values of cholesterol, triglycerides, serum potassium, creatine kinase (CK), CK-MB, cardiac tro - ponin T (cTnT) were measured. Results: The total of 192 patients were referred under the referral diagnosis of ACS and treated in the coronary unit of the CVD Clinic of the Banja Luka UCCRS. At the same time, ACS was confirmed in 178 cases. STEMI was confirmed in 86 patients (48.31 %), NSTEMI in 55 (30.90 %) and UAP in 37 (20.79 %). ACS was statistically significantly more common in men (112 men and 66 women), in particular younger men (average age for men was 62.7 and 69.2 for men and women, respectively) (U = 2.472 x 103, p < 0.001). Among the risk factors, it was found th at smoking was more often associated with STEMI (p = 0.014) and hypertension with UAP (p = 0.041). Among all param eters, all three examined cardiac biomarkers showed statistical significance (p < 0.001), namely: values at STEMI > NSTEMI > UAP. Conclusion: Half of patients with ACS did not have STEMI (which is presumably easy to diagnose). Third of patients with ACS reported atypical symptoms, which further complicates the early recognition of MI without ST elevation. Precaution is needed in women and in elderly. Determination of cTnT should be available in every examination room.
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Beekman-van Solkema G, Schoots MH, Pundziute-Do Prado G. A rare cause of acute ST-elevation myocardial infarction: case report of native aortic valve thrombosis. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 4:1-4. [PMID: 32128505 PMCID: PMC7047074 DOI: 10.1093/ehjcr/ytz232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 11/14/2022]
Abstract
Background One to 13% of all patients with the clinical diagnosis of an acute coronary syndrome (ACS) show no evidence of significant obstructive coronary artery disease on angiography. Less common causes should be considered in those situations. A very rare cause of ACS is native aortic valve thrombosis. Case summary A 69-year-old previously healthy woman presented with acute chest pain. The electrocardiogram showed an anterolateral ST-elevation myocardial infarction (STEMI). She was immediately transferred for primary percutaneous coronary intervention. Shortly after arriving in hospital her condition deteriorated, with development of cardiogenic shock necessitating cardiopulmonary resuscitation. A coronary angiogram was performed during resuscitation that did not reveal any obstructive coronary artery disease. Echocardiography showed no pericardial effusion, no significant left-sided valve pathology, no signs of an aortic dissection or pulmonary embolism. She died of cardiogenic shock of unknown cause. Permission for autopsy was obtained. Pathologic examination revealed a large anterolateral myocardial infarction caused by a mass attached to the bottom of the left coronary cusp of the native aortic valve, which was large enough to occlude the ostium of the left main coronary artery. Microscopic analysis showed a thrombus of unknown origin. The aortic valve itself showed no signs of pathology. Discussion An ST-elevation myocardial infarction due to native aortic valve thrombosis is a rare condition, especially when there are no significant valvular abnormalities. This case demonstrates that thrombosis can develop in an apparently healthy middle-aged woman without any history of thrombotic disease.
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Affiliation(s)
- Gerrie Beekman-van Solkema
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - M H Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - G Pundziute-Do Prado
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Vidal-Perez R, Abou Jokh Casas C, Agra-Bermejo RM, Alvarez-Alvarez B, Grapsa J, Fontes-Carvalho R, Rigueiro Veloso P, Garcia Acuña JM, Gonzalez-Juanatey JR. Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions. World J Cardiol 2019; 11:305-315. [PMID: 31908730 PMCID: PMC6937414 DOI: 10.4330/wjc.v11.i12.305] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). This acute coronary syndrome differs from type 1 myocardial infarction (MI) regarding patient characteristics, presentation, physiopathology, management, treatment, and prognosis. Two-thirds of MINOCA subjects present ST-segment elevation; MINOCA patients are younger, are more often female and tend to have fewer cardiovascular risk factors. Moreover, MINOCA is a working diagnosis, and defining the aetiologic mechanism is relevant because it affects patient care and prognosis. In the absence of relevant coronary artery disease, myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries, coronary microcirculation, or both. Epicardial causes of MINOCA include coronary plaque disruption, coronary dissection, and coronary spasm. Microvascular MINOCA mechanisms involve microvascular coronary spasm, takotsubo syndrome (TTS), myocarditis, and coronary thromboembolism. Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients. The diagnostic arsenal includes invasive and non-invasive techniques. Medical history and echocardiography can help indicate vasospasm or thrombosis, if one finite coronary territory is affected, or specify TTS if apical ballooning is present. Intravascular ultrasound, optical coherence tomography, and provocative testing are encouraged. Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis. MINOCA is not a benign diagnosis, and its polymorphic forms differ in prognosis. MINOCA care varies across centres, and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.
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Affiliation(s)
- Rafael Vidal-Perez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
| | - Charigan Abou Jokh Casas
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
| | - Rosa Maria Agra-Bermejo
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela 15706, Spain
| | - Belén Alvarez-Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela 15706, Spain
| | - Julia Grapsa
- Cardiology Department, St Bartholomew Hospital, Barts Health Trust, London EC1A 7BE, United Kingdom
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar Gaia, Vila Nova Gaia 4434-502, Portugal
- Faculty of Medicine University of Porto, Porto 4200-319, Portugal
| | - Pedro Rigueiro Veloso
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela 15706, Spain
| | - Jose Maria Garcia Acuña
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela 15706, Spain
| | - Jose Ramon Gonzalez-Juanatey
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela 15706, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela 15706, Spain
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184
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Pomozova TP, Lykov YV, Komarova IS, Dyatlov NV, Zhelnov VV. [Clinical and laboratory features of primary acute myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis]. ACTA ACUST UNITED AC 2019; 59:41-51. [PMID: 31876461 DOI: 10.18087/cardio.2640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
According to the literature, 40-60% of patients with acute myocardial infarction (AMI) have obstructive multivessel coronary artery disease (CA) and 8.8% of patients have non-obstructive CA lesions. And it is around these two groups of patients that there are active discussions and disputes regarding the choice of optimal treatment tactics and further prognosis. The aim of the study was to study clinical and laboratory features of development and course of primary AMI in patients with multi-and single-vessel obstructive lesion of the CA compared with patients with non-obstructive CA lesions. Methods. The study has included patients hospitalized "through the ambulance channel" in the Department of cardiac intensive care of municipal clinical hospital named after S. S. Yudin Moscow with a diagnosis "primary acute myocardial infarction", ACS with and without ST segment elevation, unstable angina in 2015-2016. The diagnosis of acute myocardial infarction (AMI) was established at the hospital stage according to the criteria of the "Third universal definition of myocardial infarction" in 2012. The study included 1240 patients who underwent coronary angiography (CAG) no later than 12 hours from the time of admission. The first group (comparison group) consisted of patients with AMI and the first detected multivessel obstructive atherosclerotic lesion of CA (664 patients), the second (interest group) consisted of patients with AMI and non-obstructive atherosclerotic lesion of CA (96 patients) meeting the MINOCA criteria. The third group consisted of patients with single-vessel obstructive lesion and complete acute occlusion of the CA (272 patients). Patients with hemodynamically significant lesions of the left CA trunk were not included in the study. The clinical and laboratory features of the course of acute primary myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis were studied. The generally accepted statistical processing methods were used. A year after discharge from the hospital, 727 patients (468 patients from the 1st group, 78 from the 2nd group, 181 from the 3rd group) were interviewed by means of a structured telephone survey about the course of the disease (collection of medical history). The median follow-up was 12 months. (interquartile range 11-13 months). The endpoints were: re-hospitalization for any reason, re-coronary event, death. The received answers are entered into questionnaires and statistically processed. Results and conclusions. In patients with AMI and non-obstructive atherosclerotic CA lesion, pain behind the sternum is observed one and a half times less often (54.2%) than in patients with obstructive CA lesion (MOAPCA 86.1%, OAPCA 89.7%) and the cardiac co duction system is almost three times more likely to be affected ( 30% versus 8.4% and 12%). Only 12.5% of patients in this group had an abnormal Q wave (Q - myocardial infarction) on the ECG, therefore, a smaller volume of myocardial damage and a lower level of troponin than in patients of groups 1 and 3. During the first year after the development of AMI, patients with obstructive coronary atherosclerosis did not experience repeated coronary events, there were no indications for conducting CAG, PCI or CABG, in contrast to patients with obstructive lesion of CA. For multivascular obstruction (group 1), PCI was performed in 9.6% of patients and 3.8% of CABG. PCI was performed in group 3 with obstructive single-vessel lesion of CA in 7.7% of patients. In patients with AMI and obstructive single-vessel atherosclerotic lesion of CA (group 3), two and a half times less often (9.1%) myocardial reperfusion injury is observed, while in patients with multivascular obstructive CA defeat, this syndrome was observed in 21.3%.
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Affiliation(s)
- T P Pomozova
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Yu V Lykov
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I S Komarova
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N V Dyatlov
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Zhelnov
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
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185
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Itzhaki Ben Zadok O, Ben-Avraham B, Hamdan A, Tovar A, Lyon A, Ben Gal T. A rare case of Takotsubo syndrome in a patient 5 months after heart transplantation. ESC Heart Fail 2019; 7:357-360. [PMID: 31851784 PMCID: PMC7083451 DOI: 10.1002/ehf2.12575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/24/2019] [Accepted: 11/11/2019] [Indexed: 12/03/2022] Open
Abstract
Takotsubo syndrome is an acute heart failure syndrome with a pathogenesis that is attributed to sympathetic stimulation. This case report describes a unique case of a 5 month heart‐transplanted female patient who developed apical ballooning on an echocardiography exam performed following an emotional stress event. Detailed clinical investigations and imaging techniques confirmed the diagnosis of Takatsubo syndrome. Our case indicates that Takatsubo's cardiomyopathy should be included in the differential diagnosis of heart‐transplanted patients presenting with sudden graft dysfunction mimicking acute graft rejection or acute coronary syndrome.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Ben-Avraham
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Tovar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Alexander Lyon
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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186
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Galli F, Bursi F, Carugo S. Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review. Front Psychol 2019; 10:2742. [PMID: 31920800 PMCID: PMC6914859 DOI: 10.3389/fpsyg.2019.02742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors ("broken heart" syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS. METHODS All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS). RESULTS Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting. CONCLUSION Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.
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Affiliation(s)
- Federica Galli
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy
| | - Francesca Bursi
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy
| | - Stefano Carugo
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy
- Department of Health Sciences, Università di Milano, Milan, Italy
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187
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MINOCA Today – Are We There Yet? JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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188
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Rao Y, Wang Y, Sun H, Chen W, Song W, Ma X, Liu L, Gu Y, Sun Y, Zhao Y. Typical ST-segment elevation myocardial infarction with normal coronary arteries: a case report. J Int Med Res 2019; 47:5903-5909. [PMID: 31642364 PMCID: PMC6862879 DOI: 10.1177/0300060519881567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a potentially multipathogenic syndrome that affects a subgroup of patients who present with acute myocardial infarction yet have no significant coronary artery disease on angiography. We herein describe a 71-year-old man with typical angina who showed inferior ST-segment elevation on electrocardiography and an increased troponin-I level. Emergency coronary angiography showed no angiographic stenosis. Cardiac magnetic resonance imaging (CMR) and myocardial contrast echocardiography (MCE) with two-dimensional speckle tracking imaging (2D-STI) were performed after coronary angiography. Good consistency was observed between the CMR findings and MCE with 2D-STI findings in identifying the potential causes of MINOCA. We explored an imaging method that is potentially more effective and accurate than CMR, namely MCE combined with 2D-STI, to identify myocardial abnormalities when angiography reveals no obstruction. This application of MCE with 2D-STI may optimize timely treatment. MINOCA has various causes, and the patient in this case was discharged with aspirin, verapamil, and atorvastatin on the presumption that the infarct had arisen from either plaque disruption or coronary spasm. In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA with reference to the relevant literature.
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Affiliation(s)
- Ying Rao
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Yu Wang
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Huang Sun
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Wenjuan Song
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Xuejuan Ma
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Liping Liu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Ying Gu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Yue Sun
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Yue Zhao
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
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189
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Fedorova SB, Kulagina IV, Ryabov VV. [Hemostatic Gene Polymorphisms in Acute Coronary Syndrome with Nonobstructive Coronary Atherosclerosis]. ACTA ACUST UNITED AC 2019; 59:14-22. [PMID: 31615384 DOI: 10.18087/cardio.2019.10.2680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE to study distribution of genes of the coagulation system, unfavorable in relation to the risk of thrombosis, and their influence on serum parameters ofthe hemostasis system in patients with nonobstructive coronary atherosclerosis (NCA) and acute coronary syndrome (ACS). MATERIALS AND METHODS We included in this nonrandomized open study patients with ACS older than 18 years with intact coronary arteries or confirmed at coronary angiography stenosis <50%. Genotypes of these patients were analyzed by 8 polymorphic variants of the hemostatic system genes which previously were found to be associated with the thrombophilia risk: F2 (20210 G>A) rs1799963, F5 (1691 G>A) rs6025, F7 (10976G>A) rs6046, F13 (163 G>T) rs5985, F1 (-455G>A) rs1800790, GP Ia - Ila (807C>t) rs1126643, GP Ilb-IIIa (1565 T>C) rs5918, PAI-I (-6755G>4G) rs1799889. Activities of protein C, Von Willebrand factor, plasminogen, and antithrombin III were also determined. RESULTS Of 913 patients with ACS in 30 (3.3%) with mean age 54±11 years we detected NCA. Acute myocardial infarction (AMI) was diagnosed in 24 (80%), unstable angina - in 6 (20%) patients. Only in 1 patient we found no carriage of thrombosis associated genotypes. The frequency of occurrence of the heterozygous genotype of the factor V gene was 1 (3%). Heterozygous genotype of the factor XIII was registered significantly more often in patients with present atherosclerotic lesion compared with those with intact coronary arteries. Mean activity of protein C was 103% [90; 110], antithrombin III - 96% [88; 103], Von Willebrand factor - 137% [114; 162], plasminogen - 109% [102; 112]. At admission lowering of antithrombin III and protein C activities was detected in 4 cases (13%). In dynamics level of these parameters was restored. Elevation of Von Willebrand factor activity at admission was detected in 14 cases (14%) and remained elevated one year after the index event. There was no association between of fibrinogen level, protein C activity, rs1800790 and rs6025 gene polymorphisms, respectively. One-year mortality was 7% (n=2). For one year occurred 1 AIM recurrence (3%), heart failure developed in 15 patients (50%), 11 patients (37%) were repetitively hospitalized due to all causes. No association was revealed between activity of studied blood serum markers and 1 -year outcomes (death, re-AIM, rehospitalization). CONCLUSION Among ACS patients 3.3% had NCA, what corresponded to the literature data. Carriage of at least 1 polymorphic variant of 8 thrombosis associated genes of the coagulation system was found in 97 % of patients with ACS and NCA. Distribution of these variants was like that in the European population and in patients with AIM at the background of stenosing atherosclerosis. Level of serum markers did not depend on distribution of polymorphic variants of the coagulation system genes, and presence of atherosclerotic coronary artery lesions. There was no association between hospital and long-term outcomes and distribution of polymorphic variants of thrombosis associated coagulation system genes, as well as levels of blood serum markers.
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Affiliation(s)
- S B Fedorova
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - I V Kulagina
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - V V Ryabov
- Сardiology Research Institute, Tomsk National Research Medical Centre
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190
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Barrett TJ, Lee AH, Smilowitz NR, Hausvater A, Fishman GI, Hochman JS, Reynolds HR, Berger JS. Whole-Blood Transcriptome Profiling Identifies Women With Myocardial Infarction With Nonobstructive Coronary Artery Disease. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002387. [PMID: 30562118 DOI: 10.1161/circgen.118.002387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Tessa J Barrett
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Angela H Lee
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Anais Hausvater
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Glenn I Fishman
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Judith S Hochman
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Harmony R Reynolds
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.)
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology Department of Medicine, New York University School of Medicine (T.J.B., A.H.L., N.R.S., A.H., G.I.F., J.S.H., H.R.R., J.S.B.).,Department of Surgery, New York University School of Medicine (J.S.B.)
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191
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Li D, Li Y, Wang X, Wu Y, Cui XY, Hu JQ, Li B, Lin Q. Diagnosis of myocardial infarction with nonobstructive coronary arteries in a young man in the setting of acute myocardial infarction after endoscopic retrograde cholangiopancreatography: A case report. World J Clin Cases 2019; 7:3062-3068. [PMID: 31624755 PMCID: PMC6795729 DOI: 10.12998/wjcc.v7.i19.3062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is characterized by chest pain as well as cardiac troponin I (cTnI) and electrocardiography (ECG) changes. Recently, clinical researchers have used the term “MINOCA” to indicate myocardial infarction with nonobstructive coronary arteries. To the best of our knowledge, no report has documented MINOCA in a young patient after choledocholithiasis by endoscopic retrograde cholangiopancreatography (ERCP).
CASE SUMMARY An 18-year-old Chinese man presented to the cardiac intensive care unit with chest pain radiating to the left shoulder for 1 h after choledocholithiasis by ERCP and the following treatment. ECG showed a sinus rhythm with ST-segment elevation in the II, III, and aVF leads compared with the baseline. Laboratory data revealed cTnI levels of 67.55 ng/mL and 80 ng/mL at the peak (relative index below 0.034 ng/mL) and creatine kinase-MB levels of 56 U/L and 543 U/L at the peak (relative index below 24 U/L). AMI was suspected, and coronary angiography was performed the second day. The results revealed a smooth angiographic appearance of all arteries. The patient had been diagnosed with gallstones and cholecystitis for four years but had not accepted treatment. He had abdominal pain and bloating a week previously and underwent ERCP and subsequent treatments on the second day of admission; 1.4 cm × 1.6 cm of stones were removed from his common bile duct during surgery. The results of his laboratory tests at admission revealed abnormal alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, total bile acid, total bilirubin, direct bilirubin, and indirect bilirubin levels. His temperature, heart rate, blood pressure, and body mass index were normal. His echocardiographic examination revealed no obvious abnormalities in the structure and movement of the ventricular wall and an estimated left ventricular ejection fraction of 57% after the heart attack. His cholesterol and triglycerides were within normal ranges, and his low-density lipoprotein cholesterol was 2.23 mmol/L (normal range 2.03-3.34 mmol). Further testing after AMI revealed nothing remarkable in his erythrocyte sedimentation rate, thyroid function, and tumour markers.
CONCLUSION We ultimately made a diagnosis of MINOCA caused by coronary artery spasm, which seemed to be the most suitable diagnosis of this young patient. We are concerned that the heart attack may have been induced by the ERCP rather than occurred coincidentally afterward, so we should investigate the timing of the event further. Additional studies are needed to unravel the underlying pathophysiology.
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Affiliation(s)
- Dong Li
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yan Li
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xuan Wang
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yang Wu
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xiao-Yun Cui
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Ji-Qiang Hu
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Bin Li
- Department of Cardiac Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Qian Lin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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192
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Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
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193
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Gaibazzi N, Martini C, Botti A, Pinazzi A, Bottazzi B, Palumbo AA. Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation in MINOCA and Tako-Tsubo Syndrome. J Am Heart Assoc 2019; 8:e013235. [PMID: 31462127 PMCID: PMC6755824 DOI: 10.1161/jaha.119.013235] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The pericoronary fat attenuation index (pFAI) has emerged as a marker of coronary inflammation, which is measurable from standard coronary computed tomography angiography (CCTA). It compares well with gold‐standard methods for the assessment of coronary inflammation and can predict future cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from a noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako‐Tsubo syndrome (TTS). Methods and Results Patients admitted with MINOCA and TTS between 2011 and 2018, who had both CCTA and cardiac magnetic resonance during or shortly after the acute phase, were selected and pFAI measured in their CCTA; pFAI was also measured in control subjects who had CCTA for atypical chest pain workup, no obstructive coronary artery disease found in their CCTA, and no cardiac events at 2‐year follow‐up. In the n=106 MINOCA/TTS patients, mean pFAI was −68.37±8.29 versus −78.03±6.20 in the n=106 controls (P<0.0001), and the difference was confirmed also when comparing mean pFAI in each coronary artery between MINOCA/TTS and controls (P<0.0001). Nonobstructive coronary plaques at CCTA, high‐risk plaques in particular, were more frequently found (P<0.01) in the MINOCA/TTS group compared with controls. Conclusions In MINOCA and TTS patients, CCTA is not only able to detect angiographically invisible atherosclerotic plaques, but its diagnostic yield can be expanded using the simple measurement of pFAI to characterize pericoronary fat tissue; in MINOCA/TTS mean pFAI demonstrates higher values compared with controls, a finding that has been associated with coronary artery inflammation.
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Affiliation(s)
- Nicola Gaibazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Chiara Martini
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Andrea Botti
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Antonio Pinazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Barbara Bottazzi
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
| | - Anselmo A Palumbo
- Cardiology and Radiology Departments Parma University Hospital Parma Italy
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194
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Rubini Gimenez M, Gonzalez Jurka L, Zellweger MJ, Haaf P. A case report of a giant hiatal hernia mimicking an ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5551445. [PMID: 31425572 PMCID: PMC6764569 DOI: 10.1093/ehjcr/ytz138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/01/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022]
Abstract
Background Acute coronary syndrome (ACS) can be a life-threatening condition. However, identification of patients with ACS can be challenging, especially among women, and clinical presentation can often overlap with other medical entities. Case summary A 61-year-old woman with a history of stable bronchial asthma presented with worsening dyspnoea for spiroergometry. During bicycle exercise testing, she developed acute chest pain and her electrocardiogram showed significant ST-segment elevations. High-sensitivity cardiac troponin was elevated and a coronary angiography was performed showing normal coronary arteries. Cardiac magnetic resonance imaging showed no signs of myocardial infarction, myocarditis or Takotsubo cardiomyopathy but the incidental finding of a giant hiatal hernia impeding the filling of the left atrium. The giant hernia was surgically corrected, and the patient’s exertional dyspnoea fully relieved during follow-up. Discussion Hiatal hernia might compress cardiac structures, cause exertional dyspnoea and mimic ST-elevation myocardial infarction.
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Affiliation(s)
- Maria Rubini Gimenez
- Department of Cardiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Leander Gonzalez Jurka
- Department of Pneumology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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195
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Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI.
Methods and design: This clinical prospective, descriptive research will enroll patients diagnosed with acute MI (STEMI or NSTEMI) identified by coronary angiography, followed by OCT imaging of the coronary arteries at the Emergency Clinical County Hospital of Târgu Mureş, Romania. The enrolled patients will be separated into two groups based on OCT examination, patients with SD and patients with no SD.
Conclusion: The underlying mechanisms of MINOCA with delayed washout phenomenon on coronary angiography is still poorly understood. Modern invasive imaging techniques are capable to assess the microstructure of the coronary artery wall and are able to offer the much needed information to elucidate the pathophysiological changes which ultimately cause the acute event. The current study offers a new, complex – clinical, invasive and noninvasive imaging, as well as biomarker-based – approach, which may lead to a better understanding and treatment of this pathology.
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196
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Perioperative Myokardischämien – ein Missverhältnis zwischen Diagnosen und Therapiemöglichkeiten? Anaesthesist 2019; 68:495-496. [DOI: 10.1007/s00101-019-0620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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197
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Kiamanesh O, Vu EN, Webber DL, Lau E, Kapeluto JE, Stuart H, Wood DA, Wong GC. Pheochromocytoma-Induced Takotsubo Syndrome Treated With Extracorporeal Membrane Oxygenation: Beware of the Apical Sparing Pattern. JACC Case Rep 2019; 1:85-90. [PMID: 34316755 PMCID: PMC8301256 DOI: 10.1016/j.jaccas.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022]
Abstract
A 45-year-old female presents with suspected acute myocardial infarction with cardiogenic shock requiring mechanical circulatory support. Pheochromocytoma-induced atypical Takotsubo syndrome is diagnosed. Clinicians should suspect high catecholamine states as a cause of the basal subtype of atypical Takotsubo syndrome. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Omid Kiamanesh
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Erik N. Vu
- Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada
| | - Douglas L. Webber
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Edgar Lau
- Department of Medicine, Richmond General Hospital, Richmond, Canada
| | | | - Heather Stuart
- Division of General Surgery, University of British Columbia, Vancouver, Canada
| | - David A. Wood
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Graham C. Wong
- Division of Cardiology, University of British Columbia, Vancouver, Canada
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198
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Fogg AJ, Welsh J, Banks E, Abhayaratna W, Korda RJ. Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures. BMJ Open 2019; 9:e026507. [PMID: 31337660 PMCID: PMC6661610 DOI: 10.1136/bmjopen-2018-026507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina. DESIGN This is a prospective cohort study. Baseline questionnaire (January 2006-April 2009) data from the Sax Institute's 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event. SETTING This was conducted in New South Wales, Australia. PARTICIPANTS The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457). OUTCOME MEASURES The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics. RESULTS Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92-1.08) for angiography and 1.51 (1.38-1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14-1.34) and 2.44 (2.16-2.75), respectively. CONCLUSIONS Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.
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Affiliation(s)
- Alexandra Jane Fogg
- Australian National University Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- The Sax Institute, Sydney, New South Wales, Australia
| | - Walter Abhayaratna
- Australian National University Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
- Division of Medicine, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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Rakowski T, De Luca G, Siudak Z, Plens K, Dziewierz A, Kleczyński P, Tokarek T, Węgiel M, Sadowski M, Dudek D. Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland: data from the ORPKI national registry. J Thromb Thrombolysis 2019; 47:462-466. [PMID: 30565147 PMCID: PMC6439254 DOI: 10.1007/s11239-018-1794-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is an important clinical problem especially in the era of extensive utilization of coronary angiography in MI patients. Its pathophysiology is poorly understood which makes diagnostics and treatment of MINOCA challenging in everyday clinical practice. The aim of the study was to assess characteristics of MINOCA patients in Poland based on data from the Polish National ORPKI Registry. In 2016, 49,893 patients with non-ST-segment elevation (NSTEMI) or ST-segment elevation (STEMI) myocardial infarction entered the ORPKI registry. MINOCA was defined as a non-obstructive coronary artery disease (CAD) and a lack of previous coronary revascularization. MINOCA was identified in 3924 (7.8%) patients and clinical presentation was more often NSTEMI than STEMI (MINOCA: 78 vs. 22%; obstructive CAD 51.1 vs. 48.9%; p < 0.0001). MINOCA patients were younger and more often females with significantly lower rates of diabetes, smoking, arterial hypertension, kidney disease, previous MI and previous stroke comparing to patients with obstructive CAD. Myocardial bridge was visualized in angiography more often in the MINOCA group (2.2 vs. 0.4%; p < 0.0001). Additional coronary assessment inducing fractional flow reserve, intravascular ultrasound, optical coherence tomography was marginally (< 1%) used in both groups. Periprocedural mortality was lower in MINOCA group (0.13% vs. 0.95%; p < 0.0001). MINOCA patients represent a significant proportion of MI patients in Poland. Due to multiple potential causes, MINOCA should be considered rather as a working diagnosis after coronary angiography and further efforts should be taken to define the cause of MI in each individual patient.
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Affiliation(s)
- Tomasz Rakowski
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland. .,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | | | | | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Tomasz Tokarek
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Węgiel
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
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200
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Choo EH, Chang K, Lee KY, Lee D, Kim JG, Ahn Y, Kim YJ, Chae SC, Cho MC, Kim CJ, Kim H, Jeong MH. Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non-Obstructive Coronary Arteries. J Am Heart Assoc 2019; 8:e011990. [PMID: 31284804 PMCID: PMC6662150 DOI: 10.1161/jaha.119.011990] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/20/2019] [Indexed: 11/16/2022]
Abstract
Background Myocardial infarction with nonobstructive coronary arteries ( MINOCA ) is a heterogeneous disease entity. Its prognosis and predictor of mortality remain unclear. This study aimed to compare the prognosis between MINOCA and myocardial infarction with obstructive coronary artery disease and identify factors related to all-cause death in MINOCA using a nation-wide, multicenter, and prospective registry. Methods and Results Among 13 104 consecutive patients enrolled, patients without previous history of significant coronary artery disease who underwent coronary angiography were selected. The primary outcome was 2-year all-cause death. Secondary outcomes were cardiac death, noncardiac death, reinfarction, and repeat revascularization. Patients with MINOCA (n=396) and myocardial infarction with obstructive coronary artery disease (n=10 871) showed similar incidence of all-cause death (9.1% versus 8.8%; hazard ratio [ HR ], 1.04; 95% CI, 0.74-1.45; P=0.83). Risks of cardiac death, noncardiac death, and reinfarction were not significantly different between the 2 groups ( HR , 0.82; 95% CI , 0.53-1.28; P=0.38; HR , 1.55; 95% CI , 0.93-2.56; P=0.09; HR , 1.23; 95% CI , 0.65-2.31; P=0.38, respectively). MINOCA patients had lower incidence of repeat revascularization (1.3% versus 7.2%; HR , 0.17; 95% CI , 0.07-0.41; P<0.001). Results were consistent after multivariable regression and propensity-score matching. In a multivariate model, several significant predictors of all-cause death of MINOCA were found, including the nonuse of renin-angiotensin system blockers ( HR , 2.63; 95% CI , 1.08-6.25; P=0.033) and statins ( HR , 2.17; 95% CI , 1.04-4.54; P=0.039). Conclusions Patients with MINOCA and those with myocardial infarction with obstructive coronary artery disease had comparable clinical outcomes. Use of renin-angiotensin system blockers and statins was associated with lower mortality in patients with MINOCA .
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Affiliation(s)
- Eun Ho Choo
- Division of CardiologyDepartment of CardiologyThe Catholic University of KoreaSeoulKorea
| | - Kiyuk Chang
- Division of CardiologyDepartment of CardiologyThe Catholic University of KoreaSeoulKorea
| | - Kwan Yong Lee
- Division of CardiologyDepartment of CardiologyThe Catholic University of KoreaSeoulKorea
| | - Dongjae Lee
- Division of CardiologyDepartment of CardiologyThe Catholic University of KoreaSeoulKorea
| | - Jae Gyung Kim
- Division of CardiologyDepartment of CardiologyThe Catholic University of KoreaSeoulKorea
| | - Youngkeun Ahn
- Department of Internal Medicine and Heart CenterChonnam National University HospitalGwangjuSouth Korea
| | - Young Jo Kim
- Department of CardiologyYeungnam University Medical CenterDaeguSouth Korea
| | - Shung Chull Chae
- Department of Internal MedicineKyungpook National University HospitalDaeguSouth Korea
| | - Myeong Chan Cho
- Cardiology DivisionDepartment of Internal MedicineChungbuk National University HospitalCheongjuSouth Korea
| | - Chong Jin Kim
- Department of Internal MedicineKyunghee University College of MedicineSeoulSouth Korea
| | - Hyo‐Soo Kim
- Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Myung Ho Jeong
- Department of Internal Medicine and Heart CenterChonnam National University HospitalGwangjuSouth Korea
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