Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI.
Methods and design: This clinical prospective, descriptive research will enroll patients diagnosed with acute MI (STEMI or NSTEMI) identified by coronary angiography, followed by OCT imaging of the coronary arteries at the Emergency Clinical County Hospital of Târgu Mureş, Romania. The enrolled patients will be separated into two groups based on OCT examination, patients with SD and patients with no SD.
Conclusion: The underlying mechanisms of MINOCA with delayed washout phenomenon on coronary angiography is still poorly understood. Modern invasive imaging techniques are capable to assess the microstructure of the coronary artery wall and are able to offer the much needed information to elucidate the pathophysiological changes which ultimately cause the acute event. The current study offers a new, complex – clinical, invasive and noninvasive imaging, as well as biomarker-based – approach, which may lead to a better understanding and treatment of this pathology.
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1. Maddox TM Ho PM Roe M Dai D Tsai TT Rumsfeld JS. Utilization of Secondary Prevention Therapies in Patients With Nonobstructive Coronary Artery Disease Identified During Cardiac Catheterization: Insights From the National Cardiovascular Data Registry Cath-PCI Registry. Circ Cardiovasc Qual Outcomes. 2010;3:632-641.
2. Agewall S Beltrame JF Reynolds HR et al. ESC Working Group Position Paper on Myocardial Infarction with Non-Obstructive Coronary Arteries. Eur Heart J. 2017;38:143-153.
3. Gehrie ER Reynolds HR Chen AY et al. Characterization and Outcomes of Women and Men with Non-ST-Segment Elevation Myocardial Infarction and Nonobstructive Coronary Artery Disease: Results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative. Am Heart J. 2009;158:688-694.
4. Larsen AI Galbraith PD Ghali WA et al. Characteristics and Outcomes of Patients with Acute Myocardial Infarction and Angiographically Normal Coronary Arteries. Am J Cardiol. 2005;9:261-263.
5. Opolski MP Spiewak M Marczak M et al. Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease. JACC Cardiovasc Imaging. 2018;pii:S1936-878X(18)30750-2.
6. Niccoli G Scalone G Crea F. Acute Myocardial Infarction with No Obstructive Coronary Atherosclerosis: Mechanisms and Management. Eur Heart J. 2015;36:475-481.
7. Kardasz I De Caterina R. Myocardial Infarction with Normal Coronary Arteries: A Conundrum with Multiple Aetiologies and Variable Prognosis: An Update. J Intern Med. 2007;261:330-348.
8. Jia H Abtahian F Aguirre AD et al. In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients with Acute Coronary Syndrome by Intravascular Optical Coherence Tomography. J Am Coll Cardiol. 2013;62:1748-1758.
9. Tearney GJ Regar E Akasaka T et al. Consensus Standards for Acquisition Measurement and Reporting of Intravascular Optical Coherence Tomography Studies. J Am Coll Cardiol. 2012;59:1058-1072.
10. Saw J Aymong E Sedlak T et al. Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes. Circ Cardiovasc Interv. 2014;7:645-655.
11. Hawkins BM Stavrakis S Rousan TA Abu-Fadel M Schechter E. Coronary Slow Flow–Prevalence and Clinical Correlations. Circ J. 2012;76:936-942.
12. Bogale N Lempereur M Sheikh I Wood D Saw J Fung A. Optical coherence tomography (OCT) evaluation of intermediate coronary lesions in patients with NSTEMI. Cardiovasc Revasc Med. 2016;17:113-118.
13. Hjort M Eggers KM Lindhagen L et al. Increased Inflammatory Activity in Patients 3 Months after Myocardial Infarction with Nonobstructive Coronary Arteries. Clin Chem. 2019;pii:clinchem.2018.301085.