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Revista médica de Chile

Print version ISSN 0034-9887

Abstract

CATALDO V., Pabla et al. Myocardial infarction with non-obstructive coronary artery disease. Diagnostic value of intravascular imaging and cardiac resonance. Rev. méd. Chile [online]. 2020, vol.148, n.8, pp.1083-1089. ISSN 0034-9887.  http://dx.doi.org/10.4067/S0034-98872020000801083.

Background:

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology.

Aim:

To describe a population with MINOCA and its multi-image assessment using IVI or CMR.

Material and Methods:

Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019.

Results:

Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died.

Conclusions:

Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Keywords : Coronary Angiography; Magnetic Resonance Imaging; Myocardial Infarction; Tomography, Optical Coherence; Ultrasonography, Interventional.

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