What is the clinical evidence from this study?

Study design: Observational. Population: Q-wave myocardial infarction with normal coronary arteries (n=21). Intervention: Medical therapy. Primary outcome: Major cardiovascular event.

January 1, 2012Open Access

Myocardial Infarction and Normal Coronary Arteries: The Experience of the Cardiology Department of Sfax, Tunisia

Key Result

Patients with Q-wave myocardial infarction and normal coronary arteries had a good prognosis on medical therapy, with no major cardiovascular events occurring over a mean follow-up of 24 months.

Study Design

Type

Observational (n=21)

Multicenter

Structured PICO

Population

21 patients with Q-wave myocardial infarction and normal coronary arteries (representing 1.5% of 1,400 Q-wave MI patients admitted between January 2006 and August 2011), mean age 44.95, 90.47% male.

Intervention

Medical management including curative anticoagulation, dual antiplatelet therapy (aspirin and clopidogrel), and thrombolytic therapy (in 9 patients).

Outcome

Death (cardiac death or all cause mortality), recurrence of MI, need for revascularization, heart failure, ventricular arrhythmia, bleeding complication, stroke, thromboembolic event, left ventricular ejection fraction and medical treatmenthard clinical

Patients presenting with Q-wave myocardial infarction and normal coronary arteries have a favorable short- and long-term prognosis when managed with an exclusive medical strategy.

Abstract

OBJECTIVE: The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed. METHODS: Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries. The prevalence rate of this entity was 1.5% (21 out of 1,400 Q wave MI patients). These patients were characterized by their young age (the mean age=44.95±14.86), male dominance (90.47%), and a high prevalence of smoking (85.71%). In this study, 4 patients have an evident spontaneous spasm shown on coronary angiography which disappeared after intracoronary injection of nitrates. Coagulation Disorders, such as activated protein C resistance (APC) resistance, protein C deficiency and antiphospholipid antibody syndrome were found in 4 of 12 patients who underwent systematic examination. One patient had a history of lung cancer which may be associated with a hypercoagulable state and may explain the occurrence of myocardial infarction with a normal coronary artery. The mean left ventricle ejection was 56. 5±12. The mean follow-up was 24±10 months. Six patients developed residual chest pain which was generally easily controlled by anti-spastic therapy and no patient had a major cardiovascular event. CONCLUSION: Patients with Q-wave MI and with normal coronary arteries seem to have a good short and long-term prognosis especially when they are treated with an exclusive medical strategy.

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