Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico

Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Bibliographic Details

Main Authors:	Cataldo V.,Pabla, Verdugo,Fernando J., Dauvergne,Christian, García,Alfonso, Antileo,Pablo, Monsalve,Rodrigo, Pineda,Fernando, Méndez,Manuel, Uriarte,Polentzi, Araya H.,Mario, Llerena,Pedro, Nauhm,Yalile, Pereira,Gonzalo, Ramos,Cristóbal, Coello V.,Marco, Garrido G.,Christian, Delgado A.,Tomas, González,Soledad, Sandoval B.,Jorge
Format:	Digital revista
Language:	Spanish / Castilian
Published:	Sociedad Médica de Santiago 2020
Online Access:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000801083
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