Key result
Patients with myocardial infarction and angiographically normal coronary arteries did not have more coronary artery disease than healthy volunteers, with 42% of patients and 43% of volunteers showing no signs of disease.
Why the study?
Do patients with myocardial infarction and angiographically normal coronary arteries (MINCA) have a greater coronary plaque burden on cardiac CT compared to healthy volunteers?
Observational (n=115)
Single-blind
Yes
Do patients with myocardial infarction and angiographically normal coronary arteries (MINCA) have a greater coronary plaque burden on cardiac CT compared to healthy volunteers?
Absolute Event Rate: 42% vs 43%
p-value: p=ns
MINCA patients show similar plaque burden to controls; leaves open non-atherosclerotic mechanisms and requires prospective validation.
OBJECTIVES: Patients presenting with acute myocardial infarction and angiographically normal coronary arteries (MINCA) represent a diagnostic and a therapeutic challenge. Cardiac computed tomography (CT) allows detection of coronary artery disease (CAD) even in the absence of significant stenosis. We aimed to investigate whether patients suffering from MINCA had a greater coronary plaque burden, as determined by cardiac CT, than a matched group of healthy volunteers. METHODS: Consecutive patients, aged 45 to 70, with MINCA were enrolled in the Stockholm metropolitan area. Patients with myocarditis were excluded using cardiovascular magnetic resonance imaging. Remaining patients underwent cardiac CT, as did a reference group of healthy volunteers matched by age and gender, with no known cardiovascular disease. Plaque burden was evaluated semi-quantitatively on a per patient and a per segment level. RESULTS: Despite a higher prevalence of smoking and hypertension, patients with MINCA did not have more CAD than healthy volunteers. Among 57 MINCA patients and 58 volunteers no signs of CAD were found in 24 (42%) and 25 (43%) respectively. On a per segment level, MINCA patients had less segments with stenosis ≥ 20% (2% vs. 5%, p<0.01), as well as a smaller proportion of large (2% vs. 4%, p<0.05) and mixed type plaques (1% vs. 4%, p<0.01). The median coronary calcium score did not differ between MINCA patients and healthy volunteers (6 vs. 8, ns). CONCLUSIONS: MINCA patients with no or minimal angiographic stenosis do not have more coronary atherosclerosis than healthy volunteers, and a large proportion of these patients do not have any signs of CAD, as determined by cardiac CT. The MINCA patient group is probably heterogeneous, with a variety of different underlying mechanisms. Non-obstructive CAD is most likely not the most prevalent cause of myocardial infarction in this patient group.
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Brolin et al. (2014) conducted an observational in Myocardial Infarction and Angiographically Normal Coronary Arteries (MINCA) (n=115). Myocardial infarction with angiographically normal coronary arteries (MINCA) vs. Healthy volunteers was evaluated on Absence of coronary artery disease (CAD) on a per-patient level as determined by cardiac CT (p=ns). Patients with myocardial infarction and angiographically normal coronary arteries did not have more coronary artery disease than healthy volunteers, with 42% of patients and 43% of volunteers showing no signs of disease.
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