Brolin Elin B, Jernberg Tomas, Brismar Torkel B, Daniel Maria, Henareh Loghman, Ripsweden Jonaz, Tornvall Per, Cederlund Kerstin
Department of Radiology, Karolinska University Hospital Huddinge and Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Section of Cardiology, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2014 Jun 17;9(6):e99783. doi: 10.1371/journal.pone.0099783. eCollection 2014.
Patients presenting with acute myocardial infarction and angiographically normal coronary arteries (MINCA) represent a diagnostic and a therapeutic challenge. Cardiac computed tomography (CT) allows detection of coronary artery disease (CAD) even in the absence of significant stenosis. We aimed to investigate whether patients suffering from MINCA had a greater coronary plaque burden, as determined by cardiac CT, than a matched group of healthy volunteers.
Consecutive patients, aged 45 to 70, with MINCA were enrolled in the Stockholm metropolitan area. Patients with myocarditis were excluded using cardiovascular magnetic resonance imaging. Remaining patients underwent cardiac CT, as did a reference group of healthy volunteers matched by age and gender, with no known cardiovascular disease. Plaque burden was evaluated semi-quantitatively on a per patient and a per segment level.
Despite a higher prevalence of smoking and hypertension, patients with MINCA did not have more CAD than healthy volunteers. Among 57 MINCA patients and 58 volunteers no signs of CAD were found in 24 (42%) and 25 (43%) respectively. On a per segment level, MINCA patients had less segments with stenosis ≥ 20% (2% vs. 5%, p<0.01), as well as a smaller proportion of large (2% vs. 4%, p<0.05) and mixed type plaques (1% vs. 4%, p<0.01). The median coronary calcium score did not differ between MINCA patients and healthy volunteers (6 vs. 8, ns).
MINCA patients with no or minimal angiographic stenosis do not have more coronary atherosclerosis than healthy volunteers, and a large proportion of these patients do not have any signs of CAD, as determined by cardiac CT. The MINCA patient group is probably heterogeneous, with a variety of different underlying mechanisms. Non-obstructive CAD is most likely not the most prevalent cause of myocardial infarction in this patient group.
表现为急性心肌梗死且冠状动脉造影正常（MINCA）的患者带来了诊断和治疗方面的挑战。心脏计算机断层扫描（CT）即使在没有明显狭窄的情况下也能检测出冠状动脉疾病（CAD）。我们旨在研究与匹配的健康志愿者组相比，经心脏CT测定，MINCA患者是否有更大的冠状动脉斑块负荷。
在斯德哥尔摩市区纳入年龄在45至70岁之间的连续MINCA患者。使用心血管磁共振成像排除心肌炎患者。其余患者接受心脏CT检查，年龄和性别匹配的无已知心血管疾病的健康志愿者参考组也接受了检查。在每位患者和每个节段水平上对斑块负荷进行半定量评估。
尽管MINCA患者吸烟和高血压的患病率较高，但他们患CAD的情况并不比健康志愿者多。在57例MINCA患者和58名志愿者中，分别有24例（42%）和25例（43%）未发现CAD迹象。在每个节段水平上，MINCA患者狭窄≥20%的节段较少（2%对5%，p<0.01），大斑块（2%对4%，p<0.05）和混合型斑块的比例也较小（1%对4%，p<0.01）。MINCA患者和健康志愿者之间的冠状动脉钙化评分中位数无差异（6对8，无显著性差异）。
血管造影无狭窄或轻度狭窄的MINCA患者的冠状动脉粥样硬化情况并不比健康志愿者更严重，并且经心脏CT测定，这些患者中有很大一部分没有CAD迹象。MINCA患者组可能是异质性的，有多种不同的潜在机制。在该患者组中，非阻塞性CAD很可能不是心肌梗死最常见的原因。
