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[Myocardial infarction with normal coronary angiography. Apropos of 9 cases. A retrospective and comparative study]
1Service de Cardiologie et de Réanimation cardiaque, Hôpital Intercommunal, Poissy.
Insights
Myocardial infarction with normal coronary arteries (MINCA) is less severe and has a better prognosis than typical myocardial infarction. MINCA patients showed lower body mass index and fewer complications, with no deaths during follow-up.
Area of Science:
- Cardiology
- Internal Medicine
- Vascular Medicine
Background:
- Myocardial infarction (MI) typically involves coronary artery disease.
- A subset of MI patients present with normal coronary arteries on angiography.
- Characteristics and prognosis of MI with normal coronary arteries (MINCA) require further elucidation.
Purpose of the Study:
- To characterize patients experiencing myocardial infarction with angiographically normal coronary arteries.
- To compare clinical features and outcomes of MINCA versus MI with stenotic coronary arteries.
Main Methods:
- Retrospective analysis of first-time MI patients admitted in 1992-1993.
- Selection criteria included age < 70 years and coronary angiography during admission.
- Comparison of clinical data, biomarkers, and short/long-term outcomes between MINCA and MI with stenotic arteries.
Main Results:
- Nine out of 109 patients had MINCA.
- MINCA patients were younger (47 vs 55 years), had lower BMI (22.9 vs 26.3 kg/m2), and a history of phlebitis.
- MINCA was associated with less severe myocardial necrosis (lower CPK peak, ST elevation, LV akinesia) and fewer acute complications (no deaths).
Conclusions:
- Myocardial infarction with normal coronary arteries appears to have a more favorable prognosis.
- This may be attributed to more limited myocardial necrosis in MINCA.
- MINCA patients experienced significantly better short-term and long-term outcomes, with no deaths during a median 2-year follow-up.
Abstract:
This retrospective study was designed to determine the characteristics of myocardial infarction with normal coronary arteries. The files of consecutive patients admitted to hospital for a first infarction in 1992 and 1993 were analysed. Patients younger than 70 years of age, who had undergone coronary angiography during their admission to hospital were selected. A total of 109 infarctions complied with these criteria and 9 of them were associated with angiographically normal coronary arteries. In this series, patients with angiographically normal coronaries tended to be younger than those with at least one stenotic coronary artery (47 +/- 13 years vs 55 +/- 11 years, p = 0.07). The sex ratio did not differ between the two groups. The body mass index of patients with normal coronary arteries was significantly lower (22.9 +/- 3.9 kg/m2 vs 26.3 +/- 3 kg/m2; p = 0.02). These patients more frequently reported a history of phlebitis (3/9 kg/cm2 vs 26.3 +/- 3 kg/cm2; p = 0.02). These patients more frequently reported a history of phlebitis (3/9 vs 2/100). The frequency of anterior and posterior infarctions was virtually the same. Myocardial infarction with normal coronary arteries appears to be less severe, as reflected by the creatine phosphokinase peak (867 +/- 268 IU/l vs 1921 +/- 1389 IU/l), the maximal sum of ST elevation (5 mm vs 16 +/- 12 mm; p = 0.05), the percentage of left ventricular akinesia on angiography (25.5 +/- 4 vs 38.7 +/- 11.8; p = 0.01), and the lower ventricular end-diastolic pressure (11.5 +/- 3.5 mmHg vs 38.7 +/- 11.8 mmHg; p = 0.02). Fewer complications were observed during the acute phase, with no deaths. During the subsequent follow-up, with a median of 2 years, no recurrent infarctions, no cardiac decompensation and no deaths were observed in the group with normal coronary arteries. Two patients presented an episode of angina and one developed a recurrent episode of phlebitis. In the other group of 100 patients, 12 deaths were observed during the acute period, followed subsequently by 2 other deaths, 10 episodes of recurrent angina, 2 recurrent infarctions and 12% of patients developed heart failure. In this series, infarction with normal coronary arteries therefore appears to have a good prognosis, possibly because of more limited myocardial necrosis. No abnormalities of haemostasis or coagulation were observed in these patients.