Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico

Cataldo V., Pabla; Verdugo, Fernando J.; Dauvergne, Christian; García, Alfonso; Antileo, Pablo; Monsalve, Rodrigo; Pineda, Fernando; Méndez, Manuel; Uriarte, Polentzi; Araya H., Mario; Llerena, Pedro; Nauhm, Yalile; Pereira, Gonzalo; Ramos, Cristóbal; Coello V., Marco; et. al.

Abstract

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.

Más información

Título según SCIELO: Infarto agudo de miocardio sin enfermedad coronaria ateroescler�tica obstructiva: utilidad de las im�genes intravasculares y resonancia card�aca en su diagn�stico
Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 148
Número: 8
Editorial: SOC MEDICA SANTIAGO
Fecha de publicación: 2020
Página de inicio: 1083
Página final: 1089
Idioma: es
DOI:

10.4067/S0034-98872020000801083

Notas: SCIELO