Coronary artery spasm-induced acute myocardial infarction in patients with myocardial infarction with non-obstructive coronary arteries

Métodos utilizados para diagnosticar o infarto do miocárdio sem lesões coronarianas obstrutivas – MINOCA

“…Também é evidenciada a importância da história clínica e da anamnese, já que a epidemiologia dos pacientes acometidos por um infarto não-obstrutivo foge ao padrão do MI-CAD (OCCHIPINTI; BUCCIARELLI-DUCCI; CAPODANNO, 2021). Sete artigos citaram algumas características mais comuns dos pacientes acometidos pelo MINOCA, como serem mais jovens e possuírem menor prevalência de fatores de risco cardiovasculares (hipertensão, dislipidemia, diabetes mellitus, histórico familiar de doença CV, tabagismo) (DEL BUONO et al, 2022;PUSTJENS et al, 2021;LINDAHL et al 2021;ZHAO et al, 2022;SUEDA;SAKAUE, 2021;YA'QOUB;ELGENDY;PEPINE, 2021;GUDENKAUF et al, 2022).…”

“…Os testes provocativos são apontados como parte do processo de investigação etiológico por cinco artigos, os quais podem ser realizados por administração de acetilcolina intracoronária ou ergonovina, permitindo o diagnóstico em grande parte dos casos de espasmo coronariano e indicando o prognóstico do paciente (SUEDA; SAKAUE, 2021;DEL BUONO et al, 2022;LAMOUR et al, 2020;MONTONE et al, 2021;GUDENKAUF et al, 2022).…”

JCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction

“…We summarized previous reports from Japan and abroad regarding the epidemiology of coronary spasm and MINOCA [43][44][45][46][47][48][49][50][51][52][53] (Table 3). The frequency of MINOCA in AMI ranged from approximately 3.5% to 11.1%, with no significant differences between reports, and the frequency of coronary spasm in MINOCA ranged from 3.7% to 72.6%, with a wide variation between reports.…”

“…62,63 A single-center, retrospective observational study in Japan reported that patients with MINOCA due to coronary spasm had 91% prevalence of smoking history. 53 As for genetic factors, a significant association between Glu298Asp mutation, one of the polymorphisms of the endothelial nitric oxide synthase (eNOS) gene, and CSA 64 has been reported, and an association between this gene polymorphism and AMI has been also reported. 65,66 In addition, an association between genetic polymorphisms of ALDH2, a member of the ALDH superfamily, and coronary angina 67 and high creatinine kinase levels in patients with ST-elevation MI 68 has been reported.…”

An Overview of the Molecular Mechanisms Associated with Myocardial Ischemic Injury: State of the Art and Translational Perspectives

“…Although this pathological event may cause acute ischemia, repetitive episodes of vasospasm-induced ischemia may eventually contribute to the development of chronic ischemic myocardial abnormalities. The mechanisms underlying coronary spasm include endothelial dysfunction, smooth muscle cells hyperactivity and other factors [ 7 ]. Endothelial damage causes a reduction in the levels of nitric oxide synthase (NOS) that causes an increase of vascular tone, which also determines changes in endothelial smooth muscle cells.…”