Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an...

Area of Science:

• Cardiology
• Pathophysiology

Background:

• Myocardial infarction (MI) in patients with angiographically normal coronary arteries (ANCA) has been recognized for over 30 years.
• The etiology and pathogenesis of ANCA-MI remain subjects of ongoing debate and research.

Purpose of the Study:

• To review current knowledge on the mechanisms underlying myocardial infarction with normal coronary arteries.
• To examine recent advancements in understanding the pathophysiology and prognosis of ANCA-MI.

Main Methods:

• Literature review of existing studies and case series on myocardial infarction with normal coronary arteries.
• Synthesis of evidence regarding potential pathogenetic mechanisms, including vasospasm, thrombosis, embolization, inflammation, endothelial dysfunction, and myocarditis.

Main Results:

• Multiple pathogenetic mechanisms contribute to ANCA-MI, including coronary vasospasm, thrombosis, embolization, inflammation, endothelial dysfunction, and myocarditis.
• Endothelial dysfunction, potentially with non-angiographically evident atherosclerosis, may be a common predisposing factor.
• Prognosis for ANCA-MI is generally favorable but likely varies depending on the specific underlying mechanism.

Conclusions:

• Myocardial infarction with normal coronary arteries is a complex condition resulting from diverse and potentially combined pathogenetic pathways.
• Understanding the specific mechanism is crucial for predicting patient outcomes, as prognosis is not uniform.
• Further research is needed to elucidate the precise roles of each mechanism and optimize patient management.