Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
J Intern Med. 2013 Feb;273(2):189-96. doi: 10.1111/j.1365-2796.2012.02567.x. Epub 2012 Aug 5.
Myocardial infarction with angiographically normal coronary arteries (MINCA) is an important subtype of myocardial infarction; however, the prevalence, underlying pathophysiology, prognosis and optimal management of this condition are still largely unknown. Cardiovascular magnetic resonance (CMR) imaging has the potential to clarify the underlying pathology in patients with MINCA. The objective of this study was to investigate the diagnostic value of CMR imaging in this group of patients.
The prospective, multicentre, observational Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study.
Coronary care units in the Stockholm metropolitan area.
Patients between 35 and 70 years of age with MINCA were consecutively included in the screening phase of the SMINC study. All patients had a typical clinical presentation, fulfilling the universal definition of myocardial infarction and had normal coronary angiography finding. Patients with known structural or coronary heart disease or other known causes of elevated troponin levels were excluded.
In total, 176 patients with MINCA were screened from 2007 to 2011. Of these, 152 underwent CMR imaging. The investigation was performed a median of 12 (interquartile range 6-28) days after hospital admission; 67% of the findings were normal, whereas 19% of patients had signs of myocardial necrosis and 7% had signs of myocarditis. The remaining patients (7%) had either unrecognized hypertrophic cardiomyopathy or could not be classified.
In this consecutive series of patients with MINCA, CMR imaging may help to differentiate between those with myocarditis, myocardial necrosis and normal myocardium. The incidence of MINCA was higher than previously reported. After excluding cases of myocarditis, MINCA consists of a large group of patients with normal CMR imaging results and a smaller group with myocardial necrosis. The aetiologies of these different imaging findings need to be explored.
经血管造影正常的冠状动脉心肌梗死（MINCA）是心肌梗死的一个重要亚型；然而，这种疾病的患病率、潜在病理生理学、预后和最佳治疗方法在很大程度上仍不清楚。心血管磁共振（CMR）成像有可能阐明 MINCA 患者的潜在病理。本研究的目的是探讨 CMR 成像在这组患者中的诊断价值。
前瞻性、多中心、观察性斯德哥尔摩无正常冠状动脉心肌梗死（SMINC）研究。
斯德哥尔摩大都市区的冠心病监护病房。
MINCA 的连续患者在 SMINC 研究的筛选阶段被纳入。所有患者均有典型临床表现，符合心肌梗死的通用定义，并具有正常的冠状动脉造影结果。排除已知结构性或冠状动脉疾病或其他已知引起肌钙蛋白水平升高的原因的患者。
2007 年至 2011 年期间，共对 176 例 MINCA 患者进行了筛查。其中，152 例行 CMR 成像。调查在住院后中位数 12（四分位间距 6-28）天进行；67%的结果正常，19%的患者有心肌坏死的迹象，7%的患者有心肌炎的迹象。其余患者（7%）有未被识别的肥厚型心肌病或无法分类。
在连续的 MINCA 患者系列中，CMR 成像有助于区分心肌炎、心肌坏死和正常心肌患者。MINCA 的发病率高于以前的报告。排除心肌炎病例后，MINCA 由一组 CMR 成像结果正常的患者和一组较小的心肌坏死患者组成。这些不同影像学表现的病因需要进一步研究。
