Coronary thrombosis in the absence of angiographically-evident obstructive coronary disease

Clinical analysis of acute myocardial infarction caused by coronary embolism

Background

This study aims to investigate the clinical and angiographic features in patients with acute myocardial infarction (AMI) induced by coronary artery embolism.

Methods

Clinical data of five patients with AMI induced by coronary artery embolism were analyzed retrospectively.

Results

One patient had left atrial myxoma, one patient had non-valvular atrial fibrillation, and three patients had rheumatic heart disease. Furthermore, one patient had mitral mechanical valve prostheses, two patients had atrial fibrillation. Coronary angiography showed the absence of significant atherosclerostic lesions in the coronary arteries except infarct related artery in five patients. Angiography suggested the presence of IRA occlusion caused by embolism.

Conclusions

The status for AMI due to coronary artery embolism usually expresses embolic material originating from the left heart chambers. Rheumatic heart disease and atrial fibrillation are the common reasons for coronary artery embolism. Coronary artery occlusion is the common performance in the results of primary coronary artery angiography. Sometimes it expresses visible signs of embolism.

Is Myocardial Infarction in Patients without Significant Stenosis on a Coronary Angiogram as Benign as Believed?

The present study aimed to investigate the clinical characteristics and 1-year outcomes of acute myocardial infarction (AMI) patients without significant stenosis on a coronary angiogram comparison with the clinical characteristics and outcomes of patients with significant coronary artery stenosis. A total of 1,220 patients with AMI were retrospectively classified into Group I (≥50% diameter stenosis, n=1,120) and Group II (<50%, n=100). Group II was further divided into two subgroups according to the underlying etiology: cryptogenic (Group II-a, n=54) and those with possible causative factors (Group II-b, n=46). Patients in Group II were younger, were more likely to be women, and were less likely to smoke and to have diabetes mellitus than were patients in Group I. The levels of cardiac enzymes, LDL-cholesterol levels, and the apo-B/A1 ratio were lower in Group II. However, 1-month and 12-month rates of major adverse cardiac events (MACE) were not significantly different between the two groups. The Group II-b subgroup comprised 29 patients with vasospasm, 11 with myocardial bridge, and 6 with spontaneous thrombolysis. Left ventricular ejection fraction and creatinine clearance were lower and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were higher in Group II-a than in Group II-b. However, outcomes including MACE and mortality at 12 months were not significantly different between the two subgroups. The 1-year outcomes of patients in Group II were similar to those of patients in Group I. The clinical outcomes in Group II-a were also similar to those of Group II-b, although the former group showed higher levels of NT-proBNP and hs-CRP.

Myocardial infarction with angiographically normal coronary arteries in the contemporary era

BACKGROUND

Myocardial infarction with angiographically normal coronary arteries (MINC) is a well recognized clinical entity, but limited data regarding outcome and prognostic factors exist in the literature. This study sought to identify clinical characteristics and etiological factors as well as outcome predictors in patients with MINC.

DESIGN

Retrospective follow-up study.

METHODS

Fifty-eight patients presenting with MINC fulfilled the study inclusion criteria. Clinical characteristics, cardiovascular risk factors, and etiologic and laboratory data were harvested and compared with those obtained from patients with myocardial infarction and single vessel coronary artery disease (MISVD). Follow-up information regarding survival and cardiac events such as angina, reinfarction and heart failure was collected and prognostic factors identified.

RESULTS

Compared with the MISVD group, MINC patients had a lower prevalence of hypercholesterolemia and ST elevation. Hypercoagulopathy, collagen tissue disorder, cocaine abuse and Takotsubo cardiomyopathy were identified etiologies in some MINC patients. During follow-up, patients with MINC were less likely to sustain reinfarction (log-rank P<0.001) and cardiovascular death (log-rank P=0.04) on Kaplan-Meier survival analysis. Recurrence of angina and heart failure were the most prevalent cardiac events in the MINC group. Cox proportional multivariate regression analysis identified left ventricular ejection fraction as an independent predictor of cardiac events in the MINC cohort.

CONCLUSION

MINC is associated with lower mortality and morbidity compared with infarction in the setting of single vessel disease. Left ventricular function is an independent predictor of poor outcome.

Normal angiogram after myocardial infarction in young patients: a prospective clinical-angiographic and long-term follow-up study

This is an observational study in which we compared the clinical characteristics and the long-term course of young patients having acute myocardial infarction and angiographically normal coronary arteries and young patients showing significant coronary artery disease. In 87 patients aged < or = 40 years who suffered an acute myocardial infarction, enrolled in a prospective study over a period of 6.5 years, coronary anatomy was determined by angiography within a month of admission. The risk factors, clinical data, ventricular function and the long-term outcome were compared between patients with normal angiograms (Group 1, n = 12) and patients with coronary artery disease (Group 2, n = 75). Patients in Group 1 had a lower number of risk factors associated with them (17% vs. 64% with > 1 risk factor, P < 0.005), were younger (32 +/- 5 vs. 36 +/- 4, P < 0.01), lighter smokers (25% vs. 55% for > or = 2 packs per day, P < 0.05), had less frequent hypertension (0 vs. 25%, P < 0.05), hypercholesterolemia (17% vs. 52%, P = 0.02) and had a lower mean total cholesterol level (201 +/- 42 vs. 245 +/- 60 mg/100 ml, P < 0.05) than patients in Group 2. They also had a more common onset of their infarction during heavy physical exertion (67% vs. 17%, P < 0.001). A history of previous myocardial infarction, infarct location, global left ventricular function and regional wall motion were similar in both groups. After a mean follow-up period of 41 +/- 23 months, no patient died or had a second myocardial infarction in Group 1, and 4 patients had died in Group 2. The appearance of angina, less frequent in Group 1 than Group 2, tended to correlate with the extension of the coronary artery disease. We concluded that young patients with myocardial infarction have good prognosis irrespective of the coronary anatomy, although patients with normal coronary angiograms had less risk factors and less frequent new ischaemic events.

Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study

HYPOTHESIS

The study was undertaken to characterize acute myocardial infarction (AMI) in young patients.

METHODS

In all 108 consecutive Mediterranean patients with AMI (102 men and 6 women), aged < or = 40 years, were prospectively included in this study over a period of 6.5 years. Coronary angiography was carried out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and in-hospital and late morbidity and mortality were evaluated.

RESULTS

Young patients with AMI represent 4.1% of the 2,644 patients admitted because of definite AMI during this period. The most common risk factors were cigarette smoking (94.5%) and hypercholesterolemia (48%). Location of the AMI was anterior in 37%, inferior in 57.5%, and non-Q in 5.5%. A history of previous angina was present in 42.5% of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started in the week prior to the AMI. In-hospital mortality and mortality during a mean follow-up of 41 +/- 23 months were 3.7 and 3.8%, respectively. The Kaplan-Meier actuarial curve assessed on 97 of 104 survivors was 100 and 94% at 1 and 5 years, respectively. Coronary arteries were angiographically normal in 17 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p < 0.05), and late angina (p < 0.01), but development of congestive heart failure and survival were similar in both groups.

CONCLUSION

These data suggest that young patients with AMI are very frequently heavy smokers, have a high incidence of angiographically normal coronary arteries, and that the short- and long-term prognosis is excellent.

Postinfarction ventricular septal rupture following thrombolysis: long-term survival in the presence of normal coronary arteries. A case report

A case of postinfarction ventricular septal rupture in a thrombolyzed patient is described. Coronary angiography revealed normal coronary arteries. The interrelations of long-term survival of postinfarction ventricular septal rupture, thrombolysis, and normal coronary arteries are discussed.

High levels of serum lipoprotein(a) in patients with ischemic heart disease with normal coronary angiogram and thromboangiitis obliterans

To determine whether lipoprotein(a) (Lp(a)) contributes to the acceleration of cardiovascular diseases without atherosclerotic lesion, we have measured serum Lp(a) level in male subjects aged 40-69 years with thromboangiitis obliterans (n = 40) and ischemic heart disease (IHD) with normal coronary angiogram (n = 35) in addition to subjects with arteriosclerosis obliterans (n = 123) and IHD with atherosclerotic coronary lesion (n = 203). Cases who had no IHD, arteriosclerosis obliterans or thromboangiitis obliterans were selected as a control group (n = 316). Subjects without any diseases or abnormal findings in physical examination and laboratory data were selected from the control group as the healthy control group (n = 156). The Lp(a) levels of arteriosclerosis obliterans and IHD with atherosclerotic coronary lesion were significantly higher (17.0 mg/dl and 13.1 mg/dl; median) than those of control and healthy control groups (9.9 mg/dl and 9.4 mg/dl, respectively) (P < 0.01), in agreement with previous reports. Furthermore, the Lp(a) level of IHD with normal coronary angiogram group was significantly higher (18.9 mg/dl) than those of the control and healthy control groups (P < 0.05). The Lp(a) level of thromboangiitis obliterans group was also much higher (21.3 mg/dl) than that of the healthy control group (P < 0.05). The current study suggests that Lp(a) is one of the independent risk factors for the development of atherosclerotic diseases such as arteriosclerosis obliterans and IHD with atherosclerotic coronary lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Bilateral coronary thrombosis in the absence of inducible coronary spasm, thrombocytosis, coagulation abnormalities, or angiographic evidence of coronary artery disease: previously undescribed method of myocardial infarction

A 32-year-old man presented with symptoms and electrocardiographic changes consistent with acute anterolateral myocardial infarction. Selective coronary angiography revealed thromboses in the infarct related artery as well as in the right coronary artery. This case is unique because bilateral in-situ coronary thrombosis producing acute myocardial infarction was documented in the absence of previously proposed mechanisms.