Læknablaðið - 01.05.2018, Blaðsíða 22

242 LÆKNAblaðið 2018/104
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Heimildir
ENGLISH SUMMARY
Introduction: The classical pathophysiological process underlying
acute coronary syndromes has been considered to be plaque rup-
ture followed by platelet activation and aggregation and subsequent
thrombus formation leading to myocardial ischemia and infarction. A
substantial number of patients with acute coronary syndromes appear
to have normal or near normal (<50% stenosis) coronary arteries on
angiography. Recently, this clinical entity has been coined MINOCA
(Myocardial Infarction with Non-Obstructive Coronary Arteries). The
purpose of this paper is to describe the proportion of MINOCA among
ACS patients in Iceland.
Material and methods: We performed a retrospective analysis of all
admissions for acute coronary syndromes at Landspitali University
Hospital, the single coronary catheterization facility in Iceland, during a
five year period between 2012 and 2016. All patients admitted for STEMI
or NSTEMI that turned out to have normal or near normal coronary
arteries were consecutively included in the study. For each patient the
diagnosis was re-evaluated according to further assessments using a
diagnostic algorithm specially constructed for this study.
Results: During the five year study period 1708 patients were studied
with coronary angiography during first hospitalization for STEMI or
NSTEMI. Among these, 225 (13.2%) had normal or non-obstructive
coronary arteries with less than 50% luminal narrowing. The final
diagnosis of these patients were plaque erosion / rupture in 72 indi-
viduals (32%), myocarditis in 33 (14.7%), takotsubo cardiomyopathy
in 28 (12.4%), type II myocardial infarction in 30 (13.3%), vasospastic
angina in 31 (13.8%) and other or undetermined cause in 31 (13.8%)
patients.
Conclusion: The proportion of MINOCA in Iceland is 13.2% of patients
admitted for acute coronary syndromes. Plaque erosion / rupture was
considered a likely cause in one third of patients with other causes
beeing evenly distributed with approximately half that frequency.
Identification of the underlying cause of MINOCA would become more
accurate with a consistent use of cardiac magnetic resonance imaging
in these patients as it provided a definitive diagnosis in all of those
studied.
MINOCA in Iceland. Acute coronary syndrome in patients with normal or nonobstructive coronary arteries
Sævar Þór Vignisson1, Ingibjörg Jóna Guðmundsdóttir2, Þórarinn Guðnason2, Ragnar Danielsen1,2, Maríanna Garðarsdóttir3, Karl Andersen1,2
1School of Health Sciences, Department of Medicine, University of Iceland, 2Department of Medicine, Division of Cardiology, Landspitalinn The National Unviversity Hospital of Iceland,
3Department of Diagnostic medicine services, Division of Radiology, Landspítalinn The National Unviversity Hospital of Iceland, Reykjavík.
Key words: MINOCA, myocardial infarction, acute coronary syndrome, plaque erosion, myocarditis, takotsubo cardiomyopathy.
Correspondence: Karl Andersen, andersen@landspitali.is
R A N N S Ó K N
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