Non-ST-Elevation Acute Myocardial Infarction With Normal Coronary Arteries: Predictors and Prognosis

Cortell, Alejandro; Sanchís, Juan; Bodı́, Vicente; Núñez, Julio; Mainar, Luis; Pellicer, Mauricio; Miñana, Gema; Santas, Enrique; Domínguez, Eloy; Palau, Patricia; Llàcer, Àngel

doi:10.1016/s1885-5857(09)73353-5

Cited by 15 publications

(20 citation statements)

References 25 publications

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“…The Egger weighted regression method to detect publication bias identified a borderline significant asymmetry for trials considering death (P=0.05). Among NObCAD patients, the risks of all-cause mortality, myocardial infarction, or all-cause mortality plus myocardial All deaths References 7,9,10,15,17,19,22,[27][28][29]31,32,[34][35][36][37][38][39][40][41][42]44 infarction did not differ significantly between the subjects with mildly obstructed versus normal artery CAD ( Table 5, Figures S65 through S67). However, few events were included in the above meta-analyses, which lacked statistical power, and no meaningful quantitative analyses could be performed to evaluate cardiac death and MACE.…”

Section: Clinical Outcomes In Nonobstructive Versus Obstructive Cadmentioning

confidence: 99%

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Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis

Pizzi

Xhyheri

Costa

et al. 2016

JAHA

107

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BackgroundDifferences in prognosis and baseline clinical presentation have been documented among patient with acute coronary syndrome and coronary artery disease with obstructive (ObCAD) or nonobstructive arteries (NObCAD), but the rates of events largely varied across single studies. We carried out a meta‐analysis to compare the clinical presentation and prognosis of NObCAD versus ObCAD acute coronary syndrome patients, as well as of the subjects with zero versus mild occlusion.Methods and ResultsSearches were made in MedLine, EMBASE, Cochrane databases, and proceedings of international meetings up to June 30, 2015. We compared the risk of events of NObCAD versus ObCAD patients using random‐effect meta‐analyses. We also performed meta‐analyses to estimate the yearly or monthly outcome rates in each single group. In NObCAD and ObCAD patients, respectively, the combined yearly rates were as follows: 2.4% versus 10.1% (all‐cause mortality); 1.2% versus 6.0% (myocardial infarction), 4.0% versus 12.8% (all‐cause mortality plus myocardial infarction), 1.4% versus 5.9% (cardiac death), and 9.2% versus 16.8% (major cardiovascular events). In the studies directly comparing NObCAD versus ObCAD, all of the above outcomes were significantly less frequent in NObCAD subjects (with risk ratios ranging from 0.33 to 0.66). No differences in any outcome rate were observed between mild occlusion (1–49% stenosis) and zero occlusion patients.Conclusions NObCAD in patients with acute coronary syndrome has a significantly lower cardiovascular risk at baseline and a subsequent lower likelihood of death or main cardiovascular events. However, these subjects are still at high risk for cardiovascular mortality and morbidity, suggesting potential undertreatment and calling for specific management.

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Section: Clinical Outcomes In Nonobstructive Versus Obstructive Cadmentioning

confidence: 99%

“…[12][13][14][15][17][18][19][20]22,23,[25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44]. †References 8,9,[12][13][14][15]23,25,26,32,41. …”

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Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis

Pizzi

Xhyheri

Costa

et al. 2016

JAHA

107

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“…As a result, he underwent a second coronary angiography, which demonstrated a patent stent without significant thrombosis. Normal coronary angiograms can be found at 8–12% in patient with acute myocardial infarction [14]. The pathophysiology of acute coronary syndrome in this case is probably not from atherosclerosis or plaque rupture, and we hypothesize that the elevated platelet count from reactive thrombocytosis caused occlusion of a small artery in the myocardium or endocardium, resulting in a second myocardial infarction with normal coronary angiogram.…”

Section: Discussionmentioning

confidence: 77%

Reactive Thrombocytosis Associated with Acute Myocardial Infarction following STEMI with Percutaneous Coronary Intervention

Dumrongmongcolgul

Mankongpaisarnrung

Sutamtewagul

et al. 2013

Case Reports in Cardiology

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The etiology of thrombocytosis can be classified into reactive and essential forms. The rate of thromboembolic events is higher in essential thrombocytosis, and these events include strokes, transient ischemic attacks, retinal artery or retinal vein occlusions, digital ischemia, and acute coronary syndrome. In a study of 732 medical and surgical patients with thrombocytosis, 88% had reactive thrombocytosis. Patients with reactive thrombocytosis do not require cytoreductive medications or antiplatelet treatment. We report a healthy 40-year-old man without any medical problems who developed a new episode of myocardial infarction associated with thrombocytosis after an episode of myocardial infarction followed by percutaneous coronary intervention. He had thrombocytosis, and his platelet function test did not reveal adequate inhibition. To treat his acute coronary syndrome, therapeutic enoxaparin was added, and clopidrogel was substituted with ticagrelor. We decided to start hydroxyurea to reduce platelets counts. Enoxaparin and hydroxyurea were discontinued when platelet count returned to baseline. JAK-2 and BCR/ABL mutations were negative. This case report highlights a clinical dilemma (reactive thrombocytosis), which is challenging in terms of management and pathophysiology.

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“…Unlike patients with STEMI, identification of the IRA in patients with the IRA in patients with NSTEMI for several reasons including a lack of ECG changes and the presence of multivessel disease. Furthermore, a significant proportion of patients who present with NSTEMI have normal coronary arteries at the time of coronary angiography . This number could be expected to increase with the increasing use of high‐sensitivity troponin.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of 3.0‐T Magnetic Resonance T1 and T2 Mapping and T2‐Weighted Dark‐Blood Imaging for the Infarct‐Related Coronary Artery in Non–ST‐Segment Elevation Myocardial Infarction

Layland

Rauhalammi

Lee

et al. 2017

JAHA

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BackgroundPatients with recent non–ST‐segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically.Methods and ResultsWe prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2‐weighted short tau inversion recovery [T2W‐STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non–ST‐segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0‐T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct‐related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W‐STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct‐related artery were similar (P=0.125), and both were superior to T2W‐STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W‐STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001).ConclusionsIn patients with non–ST‐segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W‐STIR for identifying the infarct‐related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non–ST‐segment elevation myocardial infarction.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.

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Non-ST-Elevation Acute Myocardial Infarction With Normal Coronary Arteries: Predictors and Prognosis

Cited by 15 publications

References 25 publications

Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis

Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis

Reactive Thrombocytosis Associated with Acute Myocardial Infarction following STEMI with Percutaneous Coronary Intervention

Diagnostic Accuracy of 3.0‐T Magnetic Resonance T1 and T2 Mapping and T2‐Weighted Dark‐Blood Imaging for the Infarct‐Related Coronary Artery in Non–ST‐Segment Elevation Myocardial Infarction

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