Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different areas such as biotechnology and tissue engineering have developed novel therapeutic strategies such as stem cells, nanotechnology, and robotic surgery, among others (3D printing and drugs). In addition, advances in bioengineering have led to the emergence of new diagnostic and prognostic techniques, such as quantitative flow ratio (QFR), and biomarkers for atherosclerosis. In this review, we explore novel diagnostic invasive and noninvasive modalities that allow a more detailed characterization of coronary disease. We delve into new technological revascularization procedures and pharmacological agents that target several residual cardiovascular risks, including inflammatory, thrombotic, and metabolic pathways.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA.
Nos últimos 30 anos, o tratamento de reperfusão coronariana no infarto agudo do miocárdio passou por diversas mudanças. Com o uso de um novo arsenal terapêutico como novos antiagregantes plaquetários, fibrinolíticos e, mais recentemente, a angioplastia primária, houve notável impacto em redução de mortalidade e de desfechos desfavoráveis relacionados ao evento agudo. Porém, a despeito da menor incidência desses eventos, a mortalidade continua alta, denotando a gravidade clínica dessa condição. Choque cardio-gênico, complicações mecânicas, arritmias e formação de trombo no ventrículo esquerdo são condições que impactam negativamente a evolução dos pacientes com infarto agudo do miocárdio. A principal mensagem desta publicação é incentivar o diagnóstico e a reperfusão precoce, diminuindo assim o risco de choque cardiogênico e complicações mecânicas. Caso essas complicações aconteçam, o seu reconhecimento é fundamental para que sejam iniciadas as medidas terapêuticas, priorizando a estabilização hemodi-nâmica e encaminhamento a um centro especializado com recursos adequados para o manejo individualizado e avançado do choque e demais complicações
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