Kardasz Isabella, De Caterina Raffaele
Istituto di Cardiologia e Centro di Eccellenza sull'Invecchiamento, Università degli Studi G. d'Annunzio, Chieti e Istituto di Fisiologia Clinica del CNR, Pisa.
G Ital Cardiol (Rome). 2006 Jul;7(7):474-86.
Myocardial infarction with angiographically normal coronary arteries was recognized more than 30 years ago. Since then, various series of patients with such condition have been described, but the etiology and pathogenesis still remain a matter of debate. Evidence exists for a role of coronary vasospasm, thrombosis, embolization and inflammation, per se or combined, in determining the occurrence of myocardial infarction with angiographically normal coronary arteries. Endothelial dysfunction, possibly superimposed to non-angiographically evident atherosclerosis, may be an underlying common feature predisposing to the acute event. Additionally, myocarditis may explain some of these occurrences. Myocardial infarction with normal coronary arteries is therefore likely to be the result of multiple pathogenetic mechanisms. Although most reports emphasize the good prognosis of this condition, in general much better than myocardial infarction with coronary artery disease, prognosis is likely variable according to the underlying mechanism. This review summarizes current knowledge on this condition and examines areas of recent progress.
冠状动脉造影正常的心肌梗死在30多年前就已被认识到。从那时起，已有多个系列的此类患者被描述，但病因和发病机制仍存在争议。有证据表明，冠状动脉痉挛、血栓形成、栓塞和炎症本身或相互结合，在冠状动脉造影正常的心肌梗死的发生中起作用。内皮功能障碍，可能叠加在血管造影不明显的动脉粥样硬化之上，可能是易导致急性事件的潜在共同特征。此外，心肌炎可能解释其中一些病例。因此，冠状动脉正常的心肌梗死可能是多种致病机制的结果。尽管大多数报告强调这种情况预后良好，总体上比冠状动脉疾病所致心肌梗死好得多，但根据潜在机制不同，预后可能存在差异。本综述总结了关于这种情况的现有知识，并探讨了近期取得进展的领域。
