Myocardial infarction with normal coronaries: an autopsy perspective

Area of Science:

• Cardiovascular Pathology
• Forensic Pathology
• Cardiac Autopsy

Background:

• Myocardial infarction (MI) with normal coronary arteries (MINCA) is often considered to have a favorable prognosis.
• Large series of fatal MINCA cases are rarely reported in the literature.
• Understanding the characteristics and risk factors of fatal MINCA is crucial for accurate diagnosis and prevention.

Purpose of the Study:

• To analyze postmortem cases of MI with normal coronary arteries.
• To identify patient demographics, MI characteristics, and associated risk factors.
• To evaluate the prognosis and potential causes of fatal MINCA.

Main Methods:

• Retrospective analysis of histologically confirmed MI cases with normal coronary arteries.
• Study conducted at a specialist cardiac pathology department.
• Cases identified and analyzed for risk factors between 1996 and 2010.

Main Results:

• Nineteen cases of fatal MI with normal coronary arteries were identified (mean age 33 ± 12 years).
• Risk factors were present in the majority of cases (n=14), including alcohol/drug use (n=7), inflammation (n=2), hypercoagulable state (n=3), and exertion (n=2).
• Left anterior descending artery territory was the most common infarct location (47%).

Conclusions:

• Fatal MI with normal coronary arteries can occur and may have a less favorable prognosis than previously thought.
• The causation of MINCA is complex and multifactorial, with significant associations with alcohol and drug use.
• Accurate epidemiological data from referring pathologists is essential for understanding MINCA.