Gueli Ignazio Alessio, Trimarchi Giancarlo, Coceani Michele, Todiere Giancarlo, De Gori Carmelo, Barison Andrea, Paradossi Umberto, Emdin Michele, Aimo Alberto, Clemente Alberto
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
JACC Case Rep. 2025 Jun 25;30(16):104198. doi: 10.1016/j.jaccas.2025.104198.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous condition requiring multimodal imaging for accurate diagnosis and management. Identifying the underlying etiology is crucial for guiding treatment.
A 60-year-old man with hypertension and no prior coronary artery disease presented with angina. Single-photon emission computed tomography revealed ischemia in the mid-basal septum, and coronary computed tomography angiography (CCTA) identified an anomalous septal artery with an interarterial course. Three years later, he was admitted with non-ST-segment elevation myocardial infarction. Coronary angiography showed no obstructive lesions, but cardiac magnetic resonance confirmed a recent infarction in the mid-septum. A retrospective review of prior CCTA suggested acute occlusion of the anomalous septal artery.
This case underscores the role of multimodal imaging in MINOCA, particularly in patients with coronary anomalies.
TAKE-HOME MESSAGE: CCTA and cardiac magnetic resonance are complementary in identifying the underlying cause of MINOCA and optimizing patient management.
非阻塞性冠状动脉心肌梗死（MINOCA）是一种异质性疾病，需要多模态成像进行准确诊断和管理。确定潜在病因对于指导治疗至关重要。
一名60岁男性，有高血压病史，无既往冠状动脉疾病，出现心绞痛症状。单光子发射计算机断层扫描显示中基底间隔缺血，冠状动脉计算机断层扫描血管造影（CCTA）发现一条走行于动脉间的异常间隔动脉。三年后，他因非ST段抬高型心肌梗死入院。冠状动脉造影未显示阻塞性病变，但心脏磁共振成像证实中隔近期梗死。对之前CCTA的回顾性分析提示异常间隔动脉急性闭塞。
该病例强调了多模态成像在MINOCA中的作用，特别是在冠状动脉异常患者中。
CCTA和心脏磁共振成像在确定MINOCA的潜在病因和优化患者管理方面具有互补性。
