Characterization of patients with acute myocardial infarction without coronary artery disease
Caracterización de pacientes con infarto agudo del miocardio sin enfermedad coronaria obstructiva
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Abstract
Introduction: Often when assessing thoracic pain, some patients presenting with increased levels of troponin show no significant lesions by coronary angiography. This phenomenon is reported in 9% of cases. The objective of this study is to describe the clinical features and etiology of these cases.
Methodology: Descriptive observational study. Patients admitted to 2 tertiary care hospitals with an acute myocardial infarction diagnosis who underwent some type of coronary stratification strategy between June 2013 and February 2015 were included. Patients with increased levels of troponin I and coronary angiography showing no significant lesions of coronary arteries were selected.
Results: A total of 111 acute myocardial infarction patients were included, 21 (19%) were classified as AMI without coronary artery disease (CAD); of which 85.7% experimented a typical thoracic pain as clinical manifestation, the man/woman ratio was 4:1, mean age was 58 years (between 40 and 79 years). The 62% (13/21) had hypertension, 33% (7/21) dyslipidemia and 28% (6/21) heart failure. The most relevant associated symptom was dyspnea (61%, 13/21). Etiology was confirmed in 62% (13/21), particularly associated with cardiac failure and pulmonary embolism. Microvascular disease was considered in 8 cases (38%).
Conclusions: We found a high proportion of acute myocardial infarction without CAD.
Etiology is similar to that described, predominantly, heart failure and tachyarrhythmias.
Distinguishing between this entity and an obstructive disease is complex given they share similar clinical manifestations and diagnostic test results. A better characterization of microvascular disease is required.
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