Author + information
- Received March 11, 2018
- Revision received July 19, 2018
- Accepted August 8, 2018
- Published online October 17, 2018.
- Maksymilian P. Opolski, MDa,∗ (, )
- Mateusz Spiewak, MDb,
- Magdalena Marczak, MDb,
- Artur Debski, MDa,
- Paul Knaapen, MDc,
- Stefan P. Schumacher, MDc,
- Adam D. Staruch, MDa,
- Kajetan Grodecki, MSd,
- Zbigniew Chmielak, MDa,
- Hubert Lazarczyk, MSce,
- Krzysztof Kukula, MDa,
- Pawel Tyczynski, MDa,
- Jerzy Pregowski, MDa,
- Maciej Dabrowski, MDa,
- Jacek Kadziela, MDa,
- Elzbieta Florczak, MDf,
- Anna Skrobisz, MDg and
- Adam Witkowski, MDa
- aDepartment of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
- bMagnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
- cDepartment of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- dFirst Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- eDepartment of Information Technology, Institute of Cardiology, Warsaw, Poland
- fDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
- gDepartment of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland
- ↵∗Address for correspondence:
Dr. Maksymilian P. Opolski, Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
Objectives This study sought to assess the presence and morphological features of coronary plaques on optical coherence tomography (OCT) as the causes of myocardial infarction with nonobstructive coronary arteries (MINOCA).
Background Although coronary atherosclerosis has been postulated as a potential mechanism of MINOCA, the interaction between disrupted coronary plaques and myocardial injury remains unknown.
Methods In a prospective study, consecutive patients with MI but without significant coronary stenosis (≥50%) at angiography underwent OCT and cardiac magnetic resonance (CMR) with late gadolinium-enhancement (LGE). The infarct-related artery (IRA) was identified by localization of ischemic-type LGE.
Results Thirty-eight MINOCA patients (mean age 62 ± 13 years, 55% female, 39% with ST-segment elevation) were enrolled. Maximal diameter stenosis was 35% by angiography, and 5 patients (13%) had normal angiogram results. Plaque disruption and coronary thrombus were observed in 9 patients (24%) and 7 patients (18%), respectively. Sixteen of 31 patients (52%) undergoing CMR showed LGE. Ischemic-type LGE was present in 7 patients (23%) and was more common in patients with than without plaque disruption (50% vs. 13%, respectively; p = 0.053) and coronary thrombus (67% vs. 12%, respectively; p = 0.014). In the per-lesion analysis, the IRA showed significantly more plaque disruption (40% vs. 6%; p = 0.02), thrombus (50% vs. 4%; p = 0.014), and thin-cap fibroatheroma (70% vs. 30%; p = 0.03) than the non-IRA.
Conclusions Plaque disruption and thrombus are not uncommon in MI without obstructive coronary stenoses at angiography and may be associated with the presence and location of ischemic-type myocardial injury on CMR. OCT may be valuable in identifying atherosclerotic etiology in individuals with MINOCA. (Optical Coherence Tomography in Patients With Acute Myocardial Infarction and Nonobstructive Coronary Artery Disease [SOFT-MI]; NCT02783963)
- cardiac magnetic resonance
- coronary artery disease
- myocardial infarction with nonobstructive coronary arteries
- optical coherence tomography
Supported by Iuventus Plus research grant IP2014 034073 from the Polish Ministry of Science and Higher Education. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 11, 2018.
- Revision received July 19, 2018.
- Accepted August 8, 2018.
- 2018 American College of Cardiology Foundation
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