Chen Cheng-Kang, Chang Rei-Yeuh, Chen Cheng-Yun, Chen Yung-Ping, Chu I-Tseng, Liang Hsin-Li, Hsu Chen-Tung
Division of Cardiology, Department of Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
Cardiology. 2010;115(3):186-90. doi: 10.1159/000280810. Epub 2010 Feb 5.
The purpose of the present study was to describe our experience with myocardial infarction with normal coronary arteries (MINCA) with regards to the prevalence, clinical characteristics, possible underlying etiologies (including Takotsubo cardiomyopathy, TCM) and the short- and long-term outcomes associated with this condition.
We retrospectively analyzed the records of 596 consecutive patients presenting with acute myocardial infarction over a 4-year period and identified 24 patients (14 female, 10 male) with angiographically normal coronary arteries. Demographic and clinical variables and outcomes were reviewed.
Mean patient age was 59 +/- 20 years. The presumed MINCA mechanism was TCM in 10 patients (41.7%), probable myocarditis in 5 (20.8%), coronary spasm in 4 (16.7%), coronary thrombus in 3 (12.5%) and aortic dissection in 2 patients (8.3%). After a mean follow-up of 19 +/- 14 months, 2 patients with probable myocarditis had died of cardiovascular causes, 1 patient with aortic dissection had died due to sepsis after surgery and 1 patient with TCM had died of noncardiovascular causes 2 years after discharge.
In this study, we found that MINCA occurred in 4% of patients with acute myocardial infarction undergoing emergent coronary angiography, with the most frequent underlying mechanism being TCM.
本研究旨在描述我们在冠状动脉正常的心肌梗死（MINCA）方面的经验，包括其患病率、临床特征、可能的潜在病因（包括应激性心肌病，TCM）以及与该病症相关的短期和长期预后。
我们回顾性分析了连续4年中596例急性心肌梗死患者的记录，确定了24例（14例女性，10例男性）冠状动脉造影正常的患者。对人口统计学和临床变量及预后进行了评估。
患者平均年龄为59±20岁。推测的MINCA机制为TCM的有10例（41.7%），可能为心肌炎的有5例（20.8%），冠状动脉痉挛的有4例（16.7%），冠状动脉血栓形成的有3例（12.5%），主动脉夹层的有2例（8.3%）。平均随访19±14个月后，2例可能为心肌炎的患者死于心血管原因，1例主动脉夹层患者术后死于败血症，1例TCM患者出院2年后死于非心血管原因。
在本研究中，我们发现接受急诊冠状动脉造影的急性心肌梗死患者中4%发生MINCA，最常见的潜在机制是TCM。
