PPM increases perioperative and overall mortality proportionally to its severity. The identification of predictors for PPM may be useful to identify patients who are at higher risk for PPM. The findings of this study support the implementation of strategies to prevent PPM especially in patients <70 years of age and/or with concomitant coronary artery bypass graft.

Patients with paradoxical LF-LG AS and NF-LG AS have increased risk of mortality compared with other subtypes of AS with preserved left ventricular ejection fraction, and improved outcome with AVR.

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Brugada phenocopies represent some unusual clinical cases with identical characteristics to Brugada syndrome (BrS) elicited by various clinical circumstances. We report the case of a woman exhibiting "Brugada Phenocopy" during an acute anterior myocardial infarction, highlighting differential diagnosis with true BrS and discussing possible mechanisms underlying its dynamic ECG pattern.

The frequency and profile of lymphocyte subsets within the culprit coronary artery were investigated in 33 patients with myocardial infarction and compared to their systemic circulating counterparts. T cell subsets including CD4+CD28null, activated and regulatory T-cells, TH1/TH2/TH17 phenotypes, NK and B-cells were studied in intracoronary (IC) and arterial peripheral blood (PB) samples. CD4+CD28null T-lymphocytes were significantly increased in IC compared to PB (3.7 vs. 2.9 %, p < 0.0001). Moreover, patients with more than 6 h of evolution of STEMI exhibited higher levels of CD4+CD28null T-cells suggesting that this subset may be associated with more intense myocardial damage. The rare NK subpopulation CD3−CD16+CD56− was also increased in IC samples (5.6 vs. 3.9 %, p = 0.006). CD4+CD28null T-cells and CD3−CD16+CD56− NK subpopulations were also associated with higher CK levels. Additionally, IFN-γ and IL10 were significantly higher in IC CD4+ lymphocytes. Particular immune cell populations with a pro-inflammatory profile at the site of onset were increased relative to their circulating counterparts suggesting a pathophysiological role of these cells in plaque instability, thrombi and myocardial damage.

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ResumenEl infarto agudo de miocardio sin lesiones coronarias obstructivas (MINOCA) es una afección recientemente definida en la práctica cardiológica. Su diagnóstico se basa en la angiografía coronaria, que da inicio a un proceso de búsqueda etiológica muchas veces complejo, pero con importancia pronóstica y terapéutica. Existen diferentes mecanismos involucrados en los MINOCA, que se plantean una vez excluidas la embolia pulmonar, la miocarditis y el síndrome de takotsubo. Se reconoce un patrón epicárdico de MINOCA presente en los casos de disrupción de placa, disección, vasoespasmo, y, eventualmente, embolismo coronario; y un patrón microvascular en casos de espasmo microvascular y embolia coronaria de pequeños vasos. Varias herramientas son útiles en su estudio: ecocardiografía, ventriculografía izquierda, técnicas de imagen intravascular, estudio del flujo coronario y resonancia magnética cardíaca, entre otras. Su uso debe ser guiado por el juicio clínico, y si bien no hay un algoritmo claramente establecido, incorporar todas las herramientas disponibles puede determinar la causa definitiva en algunos pacientes. La presente revisión pretende acercar al cardiólogo clínico información útil para su práctica habitual. SummaryAcute Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a recently defined condition in cardiology practice. The diagnosis starts with coronary angiography that is the beginning of an etiological research process, often complex, but with prognostic and therapeutic importance for each etiology. There are different mechanisms involved in MINOCA, which are posed once pulmonary embolism, myocarditis and takotsubo cardiomyopathy are excluded. It is described an epicardial pattern of MINOCA in cases of plaque disruption, dissection, vasospasm, and eventually coronary embolism; and a microvascular pattern in cases of microvascular spasm and small vessel coronary embolism. Several tools are useful in its study, such as echocardiography, left ventriculography, intravascular imaging techniques, study of coronary flow, and cardiac magnetic resonance, among others. Its use should be guided by clinical criteria. Despite there is no clearly established algorithm in our current practice, it is necessary to incorporate all available tools to approach the definitive MINOCA etiology whenever is possible. The aim of this review is to bring useful information to the clinical cardiologist for his daily practice.

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