Clinical and instrumental indicators of acute myocardial infarction without coronary artery obstruction
https://doi.org/10.30629/0023-2149-2022-100-4-5-209-213
Abstract
The frequency of myocardial infarction with non-obstructive coronary arteries (MINOCA) ranges from 5 to 11.1% in the structure of all myocardial infarctions. Left ventricular myocardial performance index (LV MPI) is the only echocardiographic independent predictor of unfavourable prognosis in patients with acute coronary syndrome. Purpose: to study risk factors for coronary heart disease, laboratory and echocardiographic indicators with the calculation of LV MPI in patients within the acute period of myocardial infarction. Material and methods. The study included 72 patients diagnosed with myocardial infarction. 40 patients had single-vessel coronary artery disease, 32 patients did not have stenosis > 50% according to coronary angiography. All patients underwent clinical examination, electrocardiography, clinical blood analysis and body chemistries. Echocardiography was performed on the first day of the disease. Results. A statistically significant difference among risk factors is hereditary load; in patients with MINOCA, it is the level of low-density lipoproteins and triglycerides. The glomerular filtration rate by CKD-Epi is lower by 17.6 ml/min (p = 0.0007). The LV ejection fraction, MPI is higher in patients with MINOCA (p = 0.001), in 3 patients (7.5%) who underwent percutaneous coronary intervention, LV MPI was 22.6%. Findings. 1. According to clinical signs, patients with MINOCA had a more severe course of the acute period. 2. Indicators of intracardiac hemodynamics are better in the group of patients with myocardial infarction, including the left ventricular myocardial performance index
About the Authors
I. S. GrishinRussian Federation
426000, Izhevsk
N. I. Maksimov
Russian Federation
426000, Izhevsk
References
1. Pasupathy S., Air T., Dreyer R.P. et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131(10):861–70. DOI: 10.1161/CIRCULATIONAHA.114.011201
2. Planer D., Mehran R., Ohman M.E., White H.D, Newman J.D., Xu K., Stone G.W. Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circ. Cardiovasc. Interv. 2014;7(3):285–93. PMID: 24847016. DOI: 10.1161/CIRCINTERVENTIONS.113.000606
3. Abdu F.A., Liu L., Mohammed A.Q., Luo Y., Xu S., Auckle R., Xu Y., Che W. Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up. Int. J. Cardiol. 2019;287:27–31.
4. Эрлих А.Д., Грацианский Н.А. Российский регистр острого коронарного синдрома РЕКОРД-3. Характеристика пациентов и лечение до выписки из стационара. Кардиология. 2016;4(56):16–24. [Erlikh A. D., Gratsianskiy N.A. Russian Register of acute coronary Syndrome RECORD-3. Characteristics of patients and treatment before discharge from the hospital. Kardiologiya. 2016;4(56):16–24. (In Russian)]. DOI: 10.18565/cardio.2016.4.16-24
5. Кручинова С.В., Космачева Е.Д., Порханов В.А. Сравнительный анализ демографических, анамнестических, клинико-лабо ратор ных и инструментальных данных у пациентов с инфарктом миокарда с обструктивным поражением и без обструктивного поражения коронарных артерий. Сибирский медицинский журнал. 2018;33(4):69–75. [Kruchinova S.V., Kosmacheva E.D., Por khanov V.A. Comparative analysis of demographic, anamnestic, cli nical, laboratory and instrumental data in patients with myocardial infarction with obstructive lesion and without obstructive coronary artery disease. Sibirskiy meditsinskiy zhurnal. 2018;33(4):69–75. (In Russian)]
6. Thygesen K., Alpert J.S., Jaffe A.S. et al. Fourth universal definition of myocardial infarction. Circulation. 2018;138(20):e618–e651.
7. Stein G.Y., Herscovici G., Korenfeld R. et al. Type-II myocardial infarction-patient characteristics, management and outcomes. PLoS One. 2014;9(1):e84285. DOI: 10.1371/journal.pone.0084285
8. Collet J., Thiele H., Barbato E., Barthélémy O., Bauersachs J., Bhatt D.L., Dendale P., Dorobantu M., Edvardsen T., Folliguet T., Gale C.P., Gilard M., Jobs A., Jüni P., Lambrinou E., Lewis B.S., Mehilli J., Meliga E., Merkely B., Mueller C., Roffi M., Rutten F.H., Sibbing D., Siontis G.C. Рекомендации ESC по ведению пациентов с острым коронарным синдромом без стойкого подъема сегмента ST 2020. Российский кардиологический журнал. 2021;26(3):4418. [Collet J., Thiele H., Barbato E., Barthélémy O., Bauersachs J., Bhatt D.L., Dendale P., Dorobantu M., Edvardsen T., Folliguet T., Gale C.P., Gilard M., Jobs A., Jüni P., Lambrinou E., Lewis B.S., Mehilli J., Meliga E., Merkely B., Mueller O., Roffi M., Rutten F.H., Sibbing D., Siontis G.C. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Russian Journal of Cardiology. 2021;26(3):4418. (In Russian)]. DOI: 10.15829/1560-4071-2021-4418
9. Аверков О.В., Барбараш О.Л., Бойцов С.А. и др. Диффе ренцированный подход в диагностике, формулировке диагноза, ведении больных и статистическом учете инфаркта миокарда 2-го типа (согласованная позиция). Российский кардиологический журнал. 2019;6:7–21. [Averkov O.V., Barbarash O.L., Boytsov S.A. i dr. Differentiated approach in diagnosis, formulation of diagnosis, management of patients and statistical accounting of type 2 myocardial infarction (agreed position). Russian Journal of Cardiology. 2019;6:7–21. (In Russian)]
10. Brezinov O.P., Klempfner R., Zekry S.B., Sagit B., Goldenberg I., Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine. 2017;96(9):e6226.
11. White H.D., Norris R.M., Brown M.A. et al. Left ventricular end systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76:44–51.
12. Moller J.E., Pellikka P.A., Hillis G.S. et al. Prognostic importance of diastolic function and filling pressure in patients with acute myocardial infarction. Circulation. 2006;114:438–44.
13. Осокина А.В., Каретникова В.Н., Рыженкова С.Н., Поликутина О.М., Иванова А.В., Груздева О.В., Барбараш О.Л. Биохи мические маркеры фиброза и глобальная деформация миокарда в диагностике и прогнозировании диастолической дисфункции у пациентов с инфарктом миокарда с сохраненной фракцией выброса. Российский кардиологический журнал. 2021;26(6):4255. [Osokina A.V., Karetnikova V.N., Ryzhenkova S.N., Polikutina O.M., Ivanova A.V., Gruzdeva O.V., Barbarash O.L. Biochemical markers of fibrosis and global myocardial deformity in the diagnosis and prognosis of diastolic dysfunction in patients with myocardial infarction with preserved ejection fraction. Russian Journal of Cardiology. 2021;26(6):4255. (In Russian)]
14. Kapustina A.Yu., Minushkina L.O., Alekhin M.N., Selezneva N.D., Safaryan V.I., Brazhnik V.A. et al. Left Ventricular Global Function Index as a Predictor of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome. Kardiologiia. 2021;61(8):23–31.
Review
For citations:
Grishin I.S., Maksimov N.I. Clinical and instrumental indicators of acute myocardial infarction without coronary artery obstruction. Clinical Medicine (Russian Journal). 2022;100(4-5):209-213. (In Russ.) https://doi.org/10.30629/0023-2149-2022-100-4-5-209-213