Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Myocardial Infarction with Nonobstructive Coronary Arteries (МINОСА) – a Trendy Term or a New Diagnostic Concept?

https://doi.org/10.20996/1819-6446-2018-14-5-765-773

Full Text:

Abstract

The new term «MINOCA» (myocardial infarction with nonobstructive coronary arteries) emerged in the literature about 5 years ago and characterizes the syndrome with heterogeneous etiology and pathogenesis, which reflects the development of myocardial infarction with non-obstructive lesions of the coronary  arteries, occurring in both cardiological and noncardiac diseases. The article gives detail focus on origin, definition, pathological bases of MINOCA. It also examines the role of coronary (non-obstructive atherosclerosis, microvascular dysfunction, coronary  spasm, "myocardial bridge", coronary  arteries dissection) and  non-coronary reasons, caused  by cardiac (cardiomyopathy, myocarditis) and non-cardiac (pulmonary embolism, thrombophilia) diseases.

In analyses of publications much attention is given to the discussion of diagnosis and differential diagnosis, prognosis and treatment of MINOCA. Recommended methods of examination are given depending on the  alleged cause  of the  occurrence of MINOCA. Two clinical cases  demonstrated difficulty in diagnosis of this condition and  the  importance of an individual approach. Attention is also given to the  absence of currently clinical guidelines for the  management of patients with MINOCA and  to the  significant differences in the  use  of different classes of cardiotropic drugs according to different author’s mind.

Author  gives the  opinion that  MINOCA has  a certain practical significance as a preliminary "diagnosis" before  final establishing the  disease. In conclusion, it is emphasized that the MINOCA syndrome terminology and characteristic is controversial now. This mind confirmed by a new definition of this condition in the Forth Universal Definition of Myocardial Infarction (European Society of Cardiology, 2018).

About the Author

S. S. Yakushin
I.P. Pavlov Ryazan State Medical University
Russian Federation

Sergey S. Yakushin – MD, PhD, Professor, Head of Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan, 390026.



References

1. Hochman J.S., Tamis J.E., Thompson T.D. et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med.1999;341:226-32. doi:10.1056/NEJM199907223410402.

2. Ibanez B., James S., Agewall S., Antunes M.J. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi:10.1093/eurheartj/ehx393.

3. Beltrame J.F. Assessing patients with myocardial infarction and nonobstructed coronary arteries (MINOCA). J Intern Med. 2013;273(2):182-85. doi:10.1111/j.1365-2796.2012.02591.x.

4. Agewall S., Daniel M., Eurenius L. et al. Risk factors for myocardial infarction with normal coronary arteries and myocarditis compared with myocardial infarction with coronary artery stenosis. Angiology. 2012;63(7):500-3. doi:10.1177/0003319711429560.

5. Legrand V., Deliege M., Henrard L., et al. Patients with myocardial infarction and normal coronary arteriogram. Chest. 1983;82(6):678-85. doi:10.1378/chest.82.6.678

6. Pasupathy S., Air T., Dreyer R.P., et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131(10):861-70. doi:10.1161/CIRCULATIONAHA.114.011201.

7. Gerbaud E., Harcaut E., Coste P. et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Int J Cardiovasc Imag. 2012;28(4):783-94. doi:10.1007/s10554-011-9879-1.

8. Collste O., Sorensson P., Frick M. et al. Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging: results from the Stockholm Myocardial Infarction with Normal Coronaries study. J Int Med. 2013;273(2):189-96. doi:10.1111/j.1365-2796.2012.02567.x.

9. Aviles R.J., Askari A.T., Lindahl B. et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med. 2002;346(26):2047-52. doi:10.1056/NEJ-Moa013456.

10. Mansourati J., Da Costa A., Munier S. et al. Prevalence of factor V Leiden in patients with myocardial infarction and normal coronary angiography. Thromb Haemost. 2000;83(6):822-5.

11. Dacosta A., Tardy-Poncet B., Isaaz K. et al. Prevalence of factor V Leiden (APCR) and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries. Heart. 1998;80(4):338-40. doi:10.1136/hrt.80.4.338.

12. Lande G., Dantec V., Trossaert M. et al. Do inherited prothrombotic factors have a role in myocardial infarction with normal coronary arteriogram? J Intern Med. 1998;244(6):543-4. doi:10.1111/j.1365-2796.1998.00439.x.

13. Larsen A.I., Galbraith P.D., Ghali W.A. et al. Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol. 2005;95(2):261-3. doi:10.1016/j.amjcard.2004.09.014.

14. Ong P., Athanasiadis A., Hill S. et al. Coronary artery spasm as a frequent cause of acute coronary syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. J Am Coll Cardiol. 2008;52(7):523-7. doi:10.1016/j.jacc.2008.04.050.

15. Diver D.J., Bier J.D., Ferreira P.E. et al. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol. 1994;74(6):531-7. doi:10.1016/0002-9149(94)90739-0.

16. Lanza G.A., Sestito A., Sgueglia G.A. et al. Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina. Int J Cardiol. 2007;118(1):41-7. doi:10.1016/j.ijcard.2006.06.016.

17. Da Costa A., Isaaz K., Faure E. et al. Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram: A 3-year follow-up study of 91 patients. Eur Heart J. 2001;22(16):1459-65. doi:10.1053/euhj.2000.2553.

18. Kim M.H., Park E.H., Yang D.K. et al. Role of vasospasm in acute coronary syndrome - insights from ergonovine stress echocardiography. Circ J. 2005;69(1):39-43. doi:10.1253/circj.69.39.

19. Fukai T., Koyanagi S., Takeshita A. Role of coronary vasospasm in the pathogenesis of myocardial infarction: Study in patients with no significant coronary stenosis. Am Heart J. 1993;126(6):1305-11. doi:10.1016/0002-8703(93)90527-G.

20. Niccoli G., Scalone G., Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. Eur Heart J. 2015;36(8):475-81. doi:10.1093/eurheartj/ehu469.

21. Kardasz I., De Caterina R. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J Intern Med. 2007;261(4):330-48. doi:10.1111/j.1365-2796.2007.01788.x.

22. Stone G.W., Cox D., Garcia E. et al. Normal flow (TIMI 3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarct trials. Circulation. 2001;104(6):636-41.

23. Ouldzein H., Elbaz M., Roncalli J. et al. Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: analysis by intravascular ultrasound. Ann Cardiol Angeiol (Paris). 2012;61(1):206. doi:10.1016/j.ancard.2011.07.011.

24. Reynolds H.R., Srichai M.B., Iqbal S.N. et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124(13):1414-25. doi:10.1161/CIRCULATIONAHA.111.026542.

25. Gehrie E.R., Reynolds H.R., Chen A.Y.et al. Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Am Heart J. 2009;158(4):688-94. doi:10.1016/j.ahj.2009.08.004.

26. Dyatlov N.V., Lykov Yu.V., Zhelnov V.V., Dvoretsky L.I. Some features of the pathogenesis of acute myocardial infarction with non-obstructive damage to the coronary arteries. Meditsinskiy vestnik Severnogo Kavkaza. 2017;12(3):260-5 (In Russ.).

27. Pasupathy S., Tavella R., McRae S., Beltrame J.F. Myocardial Infarction with non-obstructive coronary arteries - diagnosis and management. European Cardiology Review. 2015;10(2):79-82. doi:10.15420/ecr.2015.10.2.79.

28. Minor R.L. Jr., Scott B.D., Brown D.D., Winniford M.D. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med. 1991;115(10):797-806. doi:10.7326/0003-4819-115-10-797

29. Chen J.P. Methamphetamine-associated acute myocardial infarction and cardiogenic shock with normal coronary arteries: refractory global coronary microvascular spasm. J Invasive Cardiol. 2007;19(4):89-92.

30. Frycz-Kurek A.M., Gierlotka M., Gąsior M. et al. Patients with no significant lesions in coronary arteries and ST-segment elevation myocardial infarction have worse outcome than patients with non-ST-segment elevation myocardial infarction: analysis from PL-ACS Registry. Kardiol Pol. 2010;68(11):1211-7.

31. Kang W.Y., Jeong M.H., Ahn Y.K. et al. Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe? Int J Cardiol. 2011;146(2):207-12. doi:10.1016/j.ijcard.2009.07.001.

32. Ryabov V.V., Syrkina A.G., Belokopytova N.V., et al. Acute coronary syndrome with elevation of the ST segment in patients with nonobstructive coronary lesion: data from the RECORD-3 register. Russian Journal of Cardiology. 2017;11(151):15-21 (In Russ.).

33. Kosmacheva E.D., Kruchinova S.V., Raff S.A., Porkhanov V.A. Myocardial infarction without obstructive changes in the coronary arteries: data from the total register of ACS in the Krasnodar Territory. Neotlozhnaya Kardiologiya. 2016;4:3-10 (In Russ.).

34. Thygessen K., Alpert J.S., Jaffe A.S. et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-67. doi:10.1093/eurheartj/ehs184.

35. Thygessen K., Alpert J.S., Jaffe A.S. et al. Fourth joint ACC/AHA/WHF universal definition of myocardial infarction Eur Heart J. 2018;00:1-33. doi:10.1093/eurheartj/ehy462.


For citation:


Yakushin S.S. Myocardial Infarction with Nonobstructive Coronary Arteries (МINОСА) – a Trendy Term or a New Diagnostic Concept? Rational Pharmacotherapy in Cardiology. 2018;14(5):765-773. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-5-765-773

Views: 131


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)