Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease

Opolski, Maksymilian P.; Śpiewak, Mateusz; Marczak, Magdalena; Dębski, Artur; Knaapen, Paul; Schumacher, Stefan; Staruch, Adam D.; Grodecki, Kajetan; Chmielak, Zbigniew; Łazarczyk, Hubert; Kukuła, Krzysztof; Tyczyński, Paweł; Pręgowski, Jerzy; Dąbrowski, M; Kądziela, Jacek; Florczak, Elżbieta; Skrobisz, Anna; Witkowski, Adam

doi:10.1016/j.jcmg.2018.08.022

Cited by 89 publications

(45 citation statements)

References 18 publications

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“…Therefore, MINOCA patients are less likely to be prescribed medical therapies for a secondary prevention (statins, antithrombotic medication) than patients with evident coronary lesions on coronary angiogram. 5,13 Several studies have demonstrated that the majority of myocardial infarction are caused by the rupture of a nonobstructive, non-significant coronary plaque on coronary angiography. 12 OCT examination as a modern invasive investigation can provide a high-resolution longitudinal view and a three-dimensional vessel reconstruction, and can offer detailed information about the vessel wall ultrastructure.…”

Section: Discussionmentioning

confidence: 99%

“…4 MINOCA is characterized by evidence of myocardial injury (elevated cardiac biomarkers) with no significant atherosclerotic coronary plaque (less than 50% on coronary angiography) or flow-limiting obstructions on coronary angiography. 5 The pathophysiology of MINOCA is heterogenous, including coronary artery spasm, coronary dissection, unstable coronary plaque, Takotsubo cardiomyopathy, myocarditis, microvascular coronary artery spasm, or embolization. 6,7 Coronary angiography is able to quantify the coronary stenosis, but unable to identify the plaques at risk, due to the lack of information of the plaque structure or the coronary artery wall.…”

Section: Introductionmentioning

confidence: 99%

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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

Parajkó¹,

Mester

Păsăroiu³

et al. 2019

Journal of Interdisciplinary Medicine

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study

Parajkó¹,

Mester

Păsăroiu³

et al. 2019

Journal of Interdisciplinary Medicine

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“…At present, OCT is more sensitive than IVUS and has a higher ruptured-plaque detection rate as well as compensating for IVUS limitations in detecting bleeding and plaque ulcers. Previous studies [37] have shown a specificity and sensitivity of OCT of 75 and 92%, respectively, in the identification of plaques with a large lipid pool and a thin fiber cap. In an acute setting, left ventriculography or echocardiography should be performed to determine wall motion, enabling clinicians to make a meaningful diagnosis of Takotsubo cardiomyopathy [1].…”

Section: Clinical Assessment Of Minocamentioning

confidence: 99%

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

et al. 2020

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Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity that is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). Major advances in understanding this condition have been made in recent years. The precise pathogenesis is poorly understood and is being studied and examined further. Guidelines indicate that MINOCA is a group of heterogeneous diseases with different mechanisms of pathology. Since there are multiple possible pathological mechanisms, it is not certain that the classical secondary prevention and treatment strategy for MI with obstructive coronary artery disease (MI-CAD) is optimal for MINOCA patients. The prognosis and predictors for MINOCA patients remain unclear. Although the prognosis is slightly better for MINO-CA patients than for MI-CAD patients, MINOCA isn't always benign. The aim of this paper was to review the literature and evaluate MINOCA epidemiology, clinical features, etiology, diagnosis, treatment, and prognosis.

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“…Также следует рассмотреть возможность использования дополнительных диагностических модальностей с целью внутрисосудистой визуализации -оптической коге-рентной томографии, внутрисосудистого ультразвукового исследования. Данные методики позволяют достоверно определить наличие внутрикоронарного тромбоза, разрыва и эрозирования атеросклеротической бляшки даже при незначительной степени их выраженности [8][9][10].…”

Section: способы диагностикиunclassified

Myocardial infarction with nonobstructive coronary arteries: current state of the problem and diagnostic approaches

Shilova¹,

Sherashov²,

Першина³

et al. 2019

Klinicist

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Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease

Cited by 89 publications

References 18 publications

Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study

Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

Myocardial infarction with nonobstructive coronary arteries: current state of the problem and diagnostic approaches

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