Infarto agudo de miocardio y angina sin lesiones coronarias obstructivas minoca-anoca, implicaciones pronosticas y terapéuticas de una compleja entidad
Resumen
El infarto de miocardio sin lesiones en arterias coronarias obstructivas y la angina sin lesiones obstructivas, son entidades clínicas desconcertantes que se caracterizan por evidencia clínica de angina o infarto de miocardio con arterias coronarias normales o casi normales en la angiografía (estenosis <50%). Se realizo una revision bibliografica sobre la etiologia, clasificacion y mecanismos responsables de estas entidades. Los metodos de selección de los articulos se basaron en la literatura medica generada al respecto desde el año 2000 hasta el año 2022 a traves de pubmed, se incluyeron todos los metanalisis, estudios aleatorizados controlados, revisiones, estudios experimentales en pacientes mayores de 18 años, excluyendose aquellos que no cumplieran con los criterios de seleccion. La patogenia precisa no se comprende bien y se está estudiando y examinando más a fondo. Las guías indican que MINOCA o ANOCA son un grupo de enfermedades heterogéneas con diferentes mecanismos fisiopatologicos. Dado que existen múltiples mecanismos implicados, no es seguro que la prevención secundaria clásica y la estrategia de tratamiento para la enfermedad arterial coronaria obstructiva sea óptima para estos pacientes. La utilizacion de la tomografia de coherencia optica, la resonancia magnetica cardiaca y el ultrasonido intravascular se han planteado como estudios de estratificacion Siguen siendo muchas las dudas sobre la fisiopatologia, pronostico, estudios a posteriori tras el cateterismo cardiacos asi como conductas terapeuticas optimas. Dentro del manejo terapeutico se han descrito los farmacos anti agregantes, betabloqueantes, calcio antagonistas y los hipolipemiantes. Seran los proximos estudios con grandes cohortes de pacientes las que permitan responder adecuadamente al disponerse de evidencia cientifica de alta relevancia al respecto.
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Abdu, F., Liu, L., Mohammed, A.-Q., Luo, Y., Xu, S., & Auckle, R. (2019). Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up. International Journal of Cardiology, 287, 27–31.
Agewall, S., Beltrame, J., Reynolds, H., Niessner, A., Rosano, G., & Caforio, A. (2017). ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. European Heart Journal, 38(3), 143–153.
AM, N., T, B., KM, E., T, J., & B, L. (2018). Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. International Journal of Cardiology, 261, 18–23.
Andersson, H., Pedersen, F., Engstrøm, T., Helqvist, S., Jensen, M., & Jørgensen, E. (2017). Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease. European Heart Journal, 39(2), 102–110.
Bainey, K. R., Welsh, R. C., Alemayehu, W., Westerhout, C. M. Traboulsi, D., Anderson, T., Brass, N., Armstrong, P. W., & & Kaul, P. (2018). Population-level incidence and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA): Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study. International Journal of Cardiology, 264, 12–17.
Cenko, E., Manfrini, O., Morell, C., Das, R., Barth, J., & Hall, A. (2013). Angiotensin-converting enzyme inhibitor therapy in patients non-obstructive coronary artery disease. European Heart Journal, 34(1), 2278.
Cheema, A., Yanagawa, B., Verma, S., Bagai, A., & Liu, S. (2021). Myocardial infarction with nonobstructive coronary artery disease (MINOCA). Current Opinion in Cardiology, 36(5), 589–596.
Choo, E., Chang, K., Lee, K., Lee, D., Kim, J., & Ahn, Y. (2014). Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non‐Obstructive Coronary Arteries. Journal of the American Heart Association, 8(14), e011990.
Costa, A. Da. (2001). Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients. European Heart Journal, 22(16), 1459–1465.
Daniel, M., Agewall, S., Caidahl, K., Collste, O., Ekenbäck, C., & Frick, M. (2017). Effect of Myocardial Infarction With Nonobstructive Coronary Arteries on Physical Capacity and Quality-of-Life. The American Journal of Cardiology, 120(3), 341–346.
Eggers, K., Hjort, M., Baron, T., Jernberg, T., Nordenskjöld, A., & Tornvall, P. (2018). Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries. Journal of Internal Medicine, 285(4), 419–428.
Fernandez, M. C., Abu-Assi, E., Pousa, I. R. R. S. M., & Dominguez, E. P. D. R. L. (2019). Cardiovascular mortality in patients with MINOCA and prognostic effect of statin treatment. European Heart Journal, 1(40), 880.
Hjort, M., Lindahl, B., Baron, T., Jernberg, T., Tornvall, P., & Eggers, K. (2018). Prognosis in relation to high-sensitivity cardiac troponin T levels in patients with myocardial infarction and non-obstructive coronary arteries. American Heart Journal, 200, 60–66.
Iqbal, S., Feit, F., Mancini, G., Wood, D., Patel, R., & Pena-Sing, I. (2014). Characteristics of plaque disruption by intravascular ultrasound in women presenting with myocardial infarction without obstructive coronary artery disease. American Heart Journal, 167(5), 715–722.
Ishii, M., Kaikita, K., Sakamoto, K., Seki, T., Kawakami, K., & Nakai, M. (2020). Characteristics and in-hospital mortality of patients with myocardial infarction in the absence of obstructive coronary artery disease in super-aging society. International Journal of Cardiology, 301, 108–113.
Ishii, M., Kaikita, K., Sato, K., Yamanaga, K., Miyazaki, T., & Akasaka, T. (2016). Impact of aspirin on the prognosis in patients with coronary spasm without significant atherosclerotic stenosis. International Journal of Cardiology, 220, 328–332.
Kang, W., Jeong, M., Ahn, Y., Kim, J., Chae, S., & Kim, Y. (2011). Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe? International Journal of Cardiology, 146(2), 207–212.
Kilic, S., Aydın, G., Çoner, A., Doğan, Y., Arican, Ö., Ö Çelik, Y., Ungan, I., Tascanov, M., Düz, B., Polat, R., Özkan, V., Özyaşar, H., Tülüce, M., Kurt, K., Çetin, D., Gül, N., Inci, M., Coskun, S. Y., Arı, F., & M, H. Z. (2020). Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study. The Anatolian Journal of Cardiology, 23(3), 176–182.
Leurent, G., Langella, B., Fougerou, C., Lentz, P.-A., Larralde, A., & Bedossa, M. (2011). Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries. Archives of Cardiovascular Diseases, 104(3), 161–170.
Lindahl, B., Baron, T., Erlinge, D., Nordenskjöld, A Hadziosmanovic, N., & Gard, A. (2017). Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Circulation, 135(16), 1481–1489.
Mahajan, A., Gandhi, H., Smilowitz, N., Roe, M., Hellkamp, A., & Chiswell, K. (2019). Seasonal and circadian patterns of myocardial infarction by coronary artery disease status and sex in the ACTION Registry-GWTG. International Journal of Cardiology, 274, 16–20.
Montone, R., Niccoli, G., Fracassi, F., Russo, M., Gurgoglione, F., & Cammà, G. (2017). Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. European Heart Journal, 30(2), 91–98.
Montone, R., Niccoli, G., Fracassi, F., Russo, M., Gurgoglione, F., & Cammà, G. (2018). Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. European Heart Journal, 39(2), 91–98.
Nero, D., Agewall, S., Daniel, M., Caidahl, K., Collste, O., & Ekenbäck, C. (2019). Personality Traits in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries. The American Journal of Medicine., 132(3), 374–381.
Occhipinti, G., Capodanno, D., & Bucciarelli-Ducci, C. (2021). Diagnostic pathways in myocardial infarction with non-obstructive coronary artery disease (MINOCA). European Heart Journal Acute Cardiovascular Care, 10(7), 813–822.
Opolski, M., Spiewak, M., Marczak, M., Debski, A., Knaapen, P., & Schumacher, S. (2019). Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease. JACC: Cardiovascular Imaging, 12(11), 2210–2221.
Pasupathy, S., Air, T., Dreyer, R., Tavella, R., & Beltrame, J. (2015). Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation, 131(10), 861–870.
Pelliccia, F., Pasceri, V., Niccoli, G., Tanzilli, G., Speciale, G., & Gaudio, C. (2020). Predictors of Mortality in Myocardial Infarction and Nonobstructed Coronary Arteries: A Systematic Review and Meta-Regression. The American Journal of Medicine, 133(1), 73-83.e4.
Pirozzolo, G., Seitz, A., Athanasiadis, A., Bekeredjian, R., Sechtem, U., & Ong, P. (2019). Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA). Clinical Research in Cardiology, 109(2), 246–254.
Pizzi, C., Xhyheri, B., Costa, G., Faustino, M., Flacco, M., & Gualano, M. (2016). Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis. Journal of the American Heart Association, 5(12), e004185.
Planer, D., Mehran, R., Ohman, E., White, H., Newman, J., & Xu, K. (2014). Prognosis of Patients With Non–ST-Segment–Elevation Myocardial Infarction and Nonobstructive Coronary Artery Disease. Circulation: Cardiovascular Interventions, 7(3), 285–293.
Raparelli, V., Elharram, M., Shimony, A., Eisenberg, M., Cheema, A., & Pilote, L. (2018). Myocardial Infarction With No Obstructive Coronary Artery Disease: Angiographic and Clinical Insights in Patients With Premature Presentation. Canadian Journal of Cardiology, 34(4), 468–476.
Reynolds, H., Srichai, M., Iqbal, S., Slater, J., Mancini, G., & Feit, F. (2011). Mechanisms of Myocardial Infarction in Women Without Angiographically Obstructive Coronary Artery Disease. Circulation, 124(13), 1414–1425.
Rhew, S., Ahn, Y., Kim, M., Jang, S., Cho, K., & Hwang, S. (2012). Is Myocardial Infarction in Patients without Significant Stenosis on a Coronary Angiogram as Benign as Believed? Chonnam Medical Journal, 48(1), 39.
Rossini, R., Capodanno, D., Lettieri, C., Musumeci, G., Limbruno, U., & Molfese, M. (2013). Long-Term Outcomes of Patients With Acute Coronary Syndrome and Nonobstructive Coronary Artery Disease. The American Journal of Cardiology, 112(2), 150–155.
Sá, F. M., Ruivo, C., Santos, L., Antunes, A., Saraiva, F., & Soares, F. (2018). Myocardial infarction with nonobstructive coronary arteries. Coronary Artery Disease, 29(6), 511–515.
Safdar, B., Spatz, E., Dreyer, R., Beltrame, J., Lichtman, J., & Spertus, J. (2018a). Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. Journal of the American Heart Association, 3(7), 13.
Safdar, B., Spatz, E., Dreyer, R., Beltrame, J., Lichtman, J., & Spertus, J. (2018b). Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. Journal of the American Heart Association, 7(13), e009174.
Scalone, G., Niccoli, G., & Crea, F. (2019). Editor’s Choice- Pathophysiology, diagnosis and management of MINOCA: an update. European Heart Journal. Acute Cardiovascular Care, 8(1), 54–62.
Singh, T., Chapman, A., Dweck, M., Mills, N., & Newby, D. (2021). MINOCA: a heterogenous group of conditions associated with myocardial damage. Heart, 107(18), 1458–1464.
Smilowitz, N., Mahajan, A., Roe, M., Hellkamp, A., Chiswell, K., & Gulati, M. (2017). Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines). Circulation. Cardiovascular Quality and Outcomes, 10(12), e003443.
Tamis-Holland, J., Jneid, H., Reynolds, H., Agewall, S., Brilakis, E., & Brown, T. (2019). Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation, 139(18), e891–e908.
Tamis‐Holland, J., & Jneid, H. (2018). Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It’s Time to Face Reality! Journal of the American Heart Association, 7(13), e009635.
Thygesen, K., Alpert, J., Jaffe, A., Chaitman, B., Bax, J., & Morrow, D. (2018). Fourth Universal Definition of Myocardial Infarction. Journal of the American College of Cardiology, 72(18), 2231–2264.
Tian, J., Dauerman, H., Toma, C., Samady, H., Itoh, T., & Kuramitsu, S. (2014). Prevalence and Characteristics of TCFA and Degree of Coronary Artery Stenosis: An OCT, IVUS, and Angiographic Study. Journal of the American College of Cardiology, 64(7), 672–680.
Tornvall, P., Brolin, E., Caidahl, K., Cederlund, K., Collste, O., & Daniel, M. (2017). The value of a new cardiac magnetic resonance imaging protocol in Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) – a case-control study using historical controls from a previous study with similar inclusion criteria. BMC Cardiovascular Disorders, 17(1), 199.
Tornvall, P., Gerbaud, E., Behaghel, A., Chopard, R., Collste, O., & Laraudogoitia, E. (2015). Myocarditis or “true” infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data. Atherosclerosis., 241(1), 87–91.
Tweet, M., Codsi, E., Best, P., Gulati, R., Rose, C., & Hayes, S. (2017). Menstrual Chest Pain in Women With History of Spontaneous Coronary Artery Dissection. Journal of the American College of Cardiology, 70(18), 2308–2309.
Tweet, M., Hayes, S., Pitta, S., Simari, R., Lerman, A., & Lennon, R. (2012). Clinical Features, Management, and Prognosis of Spontaneous Coronary Artery Dissection. Circulation, 126(5), 579–588.
Derechos de autor 2022 Juan Sebastián Theran León ;Karen Vanessa Oliveros Araujo ;Elkin Javier Pardo Aparicio ;Daniel Jesús Gil Sierra;Karen Paola Colmenares Carrero
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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