Myocardial infarction without coronary artery obstruction (MINOCA) is 3 times more common in patients with NSTEMI compared to STEMI. The potential etiology of MINOCA can be divided in coronary and non-coronary causes. At the same time, an important role in its etiopathogenesis is played by microvascular coronary dysfunction (DCM). The aim of the study is to assess the feasibility of cardiac magnetic resonance (CMR) as a non-invasive method of evaluating DCM in patients with NSTEMI and in addition, to verify the substrate of MINOCA according to CMR. A diagnostic examination was carried out in 16 patients, of which coronary etiology was confirmed only in 1/3, the rest of the patients had a non-coronary etiology of the disease (myocarditis, hypertrophic cardiomyopathy and dilated cardiomyopathy). Microvascular coronary dysfunction (CDM) was determined in 30% of patients with non-coronary impairment (group I) and in 50% of those with coronary heart disease (group II) (χ² = 0.64, p> 0.05). Significant differences between groups were observed in the localization of fibrosis, so in group II, according to CMR, all patients had subendocardial fibrosis - 100%, while in group I, intramural fibrosis prevailed in 50% (n = 5), subepicardial fibrosis - 20% (n = 2) and in 20% (n = 2) both types of contrast enhancement were noted, χ² = 12.44 p < 0.05. In conclusion, CMR is an important diagnostic tool both in assessing the causes of MINOCA and in evaluating DCM in this category of patients. However, further studies are needed to improve the diagnostic accuracy of this method in the study of coronary microcirculation.

Despite the fact that women have lower incidence of non-ST-elevation myocardial infarction (NSTEMI) compared with men, they have a higher mortality, attributed to the impact of the age, higher burden of comorbidities, atypical symptoms and possible differences in the diagnosis and treatment of NSTEMI. Based on this, we aimed to evaluate the sex differences in the clinical presentation, management and major adverse cardiovascular events (MACE) of patients presenting with NSTEMI in the Republic of Moldova. Data were collected from the observational studies: retrospective (2019) and prospective (2020-2021), conducted in 3 PCI centers in Moldova, which included 351 consecutive patients with the clinical diagnosis NSTEMI. The data obtained were processed by descriptive statistical methods, using the t-test, the Pearson χ² test and the p-value. After analyzing the obtained results, we concluded that women had a lower incidence of NSTEMI, but had a higher rate of risk factors and comorbidities, compared to men, they presented more frequently atypical symptoms and more often had myocardial infarction with non-obstructive coronary arteries (MINOCA). At the same time, several gaps in the management of women with NSTEMI in the Republic of Moldova were highlighted. MACE proved to be similar at both sexes, but with a higher mortality at women. These data guide us to the need of a comprehensive approach of women with NSTEMI, taking into account the gender particularities in the clinical presentation and management of the disease.

Purpose: Evaluation of peripheral endothelial function using EndoPAT 2000 device in patients with non-ST-elevation myocardial infarction (NSTEMI) and correlation with clinical characteristics of the patients. Material and methods: The study included 39 patients with NSTEMI, hospitalized in 2 PCI centers, in the period 03.2022-03.2023. At 72 hours after admission, peripheral endothelial function was assessed using the EndoPAT 2000 device. Patients were divided into 2 groups according to the presence of peripheral endothelial dysfunction (RHI <1.67). Statistical analysis of the data was performed using the t-test and the χ2 test. Results: The average value of the reactive hyperemia index (RHI) was 1.73 ± 0.47. Endothelial dysfunction was diagnosed in 51,3% of NSTEMI patients. Group I included 19 patients with normal endothelial function (RHI>1.67), and group II – 20 patients with endothelial dysfunction (RHI<1.67). In the group of patients with endothelial dysfunction, two- or three-vessel disease prevailed (χ2=2.7, p=0.43) and a higher rate of coronary angioplasty was recorded (χ2=4.36, p=0.037). Conclusion: Peripheral endothelial dysfunction estimated by the EndoPat 2000 method is identified in 51,3% of patients with NSTEMI. The endothelial dysfunction correlated with severity of coronary lesions. Further studies are needed to assess the diagnostic and prognostic value of the method.

Purpose: To evaluate the quality of NSTEMI care in AMI centers and to identify potential gaps in the management of patients with this diagnosis. Material and methods: 550 patients with NSTEMI, hospitalized in 3 coronary angioplasty centers were enrolled in the study. The information was collected using a questionnaire composed of 179 questions, developed according to the standards of the EORP NSTEMI Registry. The research took place in two stages: retrospective observational study during 2019 and prospective - in the period 01.2020-09.2022. Results. The NSTEMI rate from the total number of patients hospitalized with AMI in the Institute of Cardiology and SP Novamed, in the period 2019-2022 was 21,6%. The results of the evaluation of NSTEMI management in the studied AMI centers are close to those reported by equivalent international registries (EORP NSTEMI, FAST-MI, PLACS, MINAP), excepting some differences in certain chapters: the diagnostic strategy of NSTE-ACS, risk stratification, diagnosis and treatment of hypercholesterolemia and the antiplatelet treatment indicated at discharge. The mortality rate in the hospital was 4,2%, at 30 days m8k– 6,0%, at 6 months after hospitalization – 10,2%, and at 12 months – 12,8%. Conclusions. The rate of NSTEMI in the Republic of Moldova is lower than that reported by the international registers of IMA, while the mortality indicators are higher. These discrepancies are largely explained by gaps in NSTEMI management identified within the studied AMI centers.