Pasupathy Sivabaskari, Rodgers Susan, Tavella Rosanna, McRae Simon, Beltrame John F
Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
TH Open. 2018 May 3;2(2):e167-e172. doi: 10.1055/s-0038-1645875. eCollection 2018 Apr.
Patients presenting with myocardial infarction (MI) in the absence of obstructive coronary artery disease (CAD) is termed MI with nonobstructive coronary arteries (MINOCA). The underlying pathophysiology of MINOCA is multifactorial and in situ formation and subsequent spontaneous lysis of a coronary thrombus is often hypothesized as one of the mechanisms. The objective of this study is to determine whether MINOCA patients had a greater prothrombotic tendency in comparison to MI patients with obstructive CAD (MICAD). Prospectively, blood samples of 25 consecutive MINOCA patients (58 (interquartile range [IQR]: 48, 75) years, 48% women) and 25 age-/gender-matched MICAD patients (58 (IQR: 50, 66) years, 48% women) were obtained at 1 month after the initial presentation and overall thrombin generation potential and congenital/acquired thrombophilia states were assessed. As regard to results, overall thrombin generation parameters were similar ( > 0.05) between the MINOCA and MICAD groups, highlighting similar endogenous thrombin potential (1,590 nM/min; IQR: 1,380, 2,000 vs. 1,750 nM/min; IQR: 1,500, 2,040, respectively). There were no significant differences between MINOCA and MICAD, respectively, in respect to the numbers of patients with congenital thrombophilia states including factor V Leiden (0 vs. 4%) and prothrombin gene mutation (8 vs. 4%), decreased antithrombin (8 vs. 0%), protein C (0 vs. 0%), and protein S (4 vs. 0%). None of the patients demonstrated presence of lupus anticoagulant and anticardiolipin antibodies. Although MINOCA patients revealed thrombotic characteristics that are similar to those with MICAD, the results from this study are inconclusive and a larger study with healthy control subjects is required to assess the risk of thrombosis in MINOCA.
在无阻塞性冠状动脉疾病（CAD）情况下出现心肌梗死（MI）的患者被称为非阻塞性冠状动脉心肌梗死（MINOCA）。MINOCA的潜在病理生理学是多因素的，冠状动脉血栓的原位形成及随后的自发溶解常被假定为其机制之一。本研究的目的是确定与阻塞性CAD心肌梗死（MICAD）患者相比，MINOCA患者是否具有更强的血栓形成倾向。前瞻性地，在初次就诊后1个月获取了25例连续的MINOCA患者（年龄58岁（四分位间距[IQR]：48，75），48%为女性）和25例年龄及性别匹配的MICAD患者（年龄58岁（IQR：50，66），48%为女性）的血样，并评估了总体凝血酶生成潜能以及先天性/获得性血栓形成倾向状态。关于结果，MINOCA组和MICAD组之间的总体凝血酶生成参数相似（P＞0.05），突出显示了相似的内源性凝血酶潜能（分别为1590 nM/分钟；IQR：1380，2000与1750 nM/分钟；IQR：1500，2040）。在包括因子V莱顿突变（0%对4%）和凝血酶原基因突变（8%对4%）、抗凝血酶降低（8%对0%）、蛋白C（0%对0%）以及蛋白S（4%对0%）等先天性血栓形成倾向状态的患者数量方面，MINOCA组和MICAD组之间分别无显著差异。没有患者表现出狼疮抗凝物和抗心磷脂抗体。尽管MINOCA患者显示出与MICAD患者相似的血栓形成特征，但本研究结果尚无定论，需要进行一项纳入健康对照受试者的更大规模研究来评估MINOCA患者的血栓形成风险。
