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Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

World Journal of Cardiology 2019年第12期11卷 305-315页

作者： Rafael Vidal-Perez Charigan Abou Jokh Casas Rosa Maria Agra-Bermejo Belén Alvarez-Alvarez Julia Grapsa Ricardo Fontes-Carvalho pedro rigueiro veloso Jose Maria Garcia Acuña Jose Ramon Gonzalez-Juanatey Cardiology Department Hospital Clinico Universitario de SantiagoSantiago de Compostela 15706Spain Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares(CIBERCV) Santiago de Compostela 15706Spain Cardiology Department St Bartholomew HospitalBarts Health TrustLondon EC1A 7BEUnited Kingdom Cardiology Department Centro Hospitalar GaiaVila Nova Gaia 4434-502Portugal Faculty of Medicine University of Porto Porto 4200-319Portugal

Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and ***-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk ***,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and *** the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or *** causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary *** MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary *** angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA *** diagnostic arsenal includes invasive and non-invasive *** history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is *** ultrasound,optical coherence tomography,and provocative testing are *** magnetic resonance is a cornerstone in myocarditis *** is not a benign diagnosis,and its polymorphic forms differ in *** care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.

关键词： Myocardial infarction Non-obstructive coronary Myocardial infarction with non-obstructive coronary arteries Management Prognosis

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