Unraveling the Association Between Myocardial Infarction of Nonobstructive Coronary Arteries and Anti-phospholipid Syndrome

Ramjas, Vishal; Jain, Akansha; Lee, Rholter Dave M; Fioni, Fioni; Tawfik, Nouran; Sandhu, Osama; Hamid, Pousette

doi:10.7759/cureus.17002

Cited by 4 publications

(3 citation statements)

References 46 publications

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“…Условно выделяют первичный АФС и вторичный АФС, ассоциированный с другими аутоиммунными заболеваниями (наиболее часто с системной красной волчанкой) [27]. Конечно, частота возникновения ИМ на фоне АФС невелика - всего 2,8% [28]. Однако данная проблема все равно требует обсуждения, поскольку имеет специфическое лечение.…”

Section: Myocardial Infarction In Young Patientsunclassified

Myocardial infarction in young patients. Is everything so obvious?

Zykov,

Barbarash

2024

Evrazijskij kardiologičeskij žurnal

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The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.

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Section: Myocardial Infarction In Young Patientsunclassified

Myocardial infarction in young patients. Is everything so obvious?

Zykov,

Barbarash

2024

Evrazijskij kardiologičeskij žurnal

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“…The prevalence of myocardial infarction (usually ST-elevation myocardial infarction) in patients with APS is 1.2% and is further elevated in those with concurrent SLE (3.8%), underlining the significant contribution of thromboembolic activity in acute coronary syndromes in APS [ 34 ]. A number of studies have highlighted the association between APS and myocardial infarction with non-obstructive coronary arteries (MINOCA) [ 37 , 38 , 39 , 40 , 41 ], with APS that may be diagnosed in up to 15.5% of patients with MINOCA [ 42 ].…”

Section: Pathophysiology Of Antiphospholipid Syndrome With a Focus On...mentioning

confidence: 99%

Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults

Bernardi,

Spadafora,

Andaloro

et al. 2024

JCM

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Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein I (β2-GPI-Ab), and anti-cardiolipin (aCL). Together with clinical data, these antibodies are the diagnostic standard. However, the diagnosis of APS in older adults may be challenging and, in the diagnostic workup of thromboembolic complications, it is an underestimated etiology. The therapeutic management of APS requires distinguishing two groups with differential risks of thromboembolic complications. The standard therapy is based on low-dose aspirin in the low-risk group and vitamin K antagonists in the high-risk group. The value of direct oral anticoagulants is currently controversial. The potential role of monoclonal antibodies is investigated. For example, rituximab is currently recommended in catastrophic antiphospholipid antibody syndrome. Research is ongoing on other monoclonal antibodies, such as daratumumab and obinutuzumab. This narrative review illustrates the pathophysiological mechanisms of APS, with a particular emphasis on cardiovascular complications and their impact in older adults. This article also highlights advancements in the diagnosis, risk stratification, and management of APS.

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“…This is partly mediated by traditional cardiovascular risk factors, but mainly depends on systemic inflammation as a promoter of endothelial dysfunction ( 42 ). Systemic lupus erythematosus and antiphospholipid syndrome have been studied most in this specific setting, as an association between them and both obstructive CAD and MINOCA was demonstrated ( 43 ). Among possible pathophysiological mechanisms, hypercoagulability can enhance thromboembolism, but microvascular dysfunction and coronary vasospasm have been described as well ( 41 , 44 ).…”

Section: Risk Factors and Comorbiditiesmentioning

confidence: 99%

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

Merlo

Troccolo

Piredda

et al. 2022

Front. Cardiovasc. Med.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA), despite a lower burden of coronary atherosclerosis, has a non-negligible prognostic impact. The label of MINOCA includes an array of different aetiologies and pathologic conditions, thus the identification of the underlying disease is crucial to patient management. Myocardial infarction with obstructive coronary artery disease and MINOCA share only some risk factors and comorbid conditions. While traditional cardiovascular risk factors have a lower prevalence in MINOCA patients, atypical ones—e.g., anxiety, depression, and autoimmune diseases—are much more frequent in this population. Other conditions—e.g., pregnancy, cancer, and anti-cancer therapy—can predispose to or even induce MINOCA through various mechanisms. The evidence of such risk factors for MINOCA is still scarce and contradicting, as no randomised controlled trials exist in this field. In our work, we performed a review of registries, clinical studies, and case reports of MINOCA, in order to summarise the available data and analyse its possibile pathogenic mechanisms.

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Unraveling the Association Between Myocardial Infarction of Nonobstructive Coronary Arteries and Anti-phospholipid Syndrome

Cited by 4 publications

References 46 publications

Myocardial infarction in young patients. Is everything so obvious?

Myocardial infarction in young patients. Is everything so obvious?

Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

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