Management and Outcomes in Patients with a Diagnosis of Myocardial Infarction but with Normal Coronary Arteries Angiographically

Abstract

The management of patients with chest pain, elevated troponin and unobstructed coronaries on coronary angiography poses a management dilemma. In such patients other differential causes of chest pain need to be excluded. The use of alternative imaging techniques such as intravascular ultrasound or optical coherance tomography enable direct visualisation of the coronary arteries to identify plaque rupture and coronary dissection. Cardiac magnetic resonance imaging is also useful in these patients as areas of myocardial necrosis can be identified. Making an accurate diagnosis is imperative as this has implications for treatment. If an incorrect diagnosis of acute coronary syndrome is made then dual antiplatelet therapy may be prescribed which is not without risk. Furthermore a diagnosis of an acute coronary syndrome has implications on psychological wellbeing, medical insurance and employment for the patient.