非阻塞性冠状动脉心肌梗死(MINOCA)研究进展
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摘要
非阻塞性冠状动脉心肌梗死(MINOCA)是一种潜在多病因综合征。MINOCA发病率估计占急性心肌梗死患者的1%~14%,多数病例类似于阻塞性冠状动脉心肌梗死。本病重要的是确定多种潜在的病因,采取不同的治疗方法。MINOCA病因不同,其预后也不同。本文对MINOCA的流行病学和临床特征,病因、机制、诊断、治疗和预后进行了综述。
Myocardial infarction(MI)with non-obstructive coronary arteries(MINOCA)is a syndrome with underlying many causes.MINOCA incidence is estimated to be between 1%and 14%of the patients with acute MI.and in many cases,it is similar to that of MI with obstructive coronary arteries.It is important to determine the multiple potential underling causes that may be responsible,many of which require different treatment.The prognosis is extremely variable,depending on the cause of MINOCA.It is reviewed epidemiology and clinical characteristics,pathogenesis,mechanisms,diagnosis and treatment of MINOCA.
Myocardial infarction(MI)with non-obstructive coronary arteries(MINOCA)is a syndrome with underlying many causes.MINOCA incidence is estimated to be between 1%and 14%of the patients with acute MI.and in many cases,it is similar to that of MI with obstructive coronary arteries.It is important to determine the multiple potential underling causes that may be responsible,many of which require different treatment.The prognosis is extremely variable,depending on the cause of MINOCA.It is reviewed epidemiology and clinical characteristics,pathogenesis,mechanisms,diagnosis and treatment of MINOCA.
引文
1.Agewall S,Beltrame JF,Reynolds HR,et al.ESC working group position paper on myocardial infarction with non-obstructive coronary arteries.Eur Heart J,2016,38(3):w 149.
2.Beltrame JF.Assessing patients with myocardial infarction and nonobstructed coronary arteries(MINOCA).J Med,2013,273(2):182-185.
3.Pasupathy S,Air T,Dreyer RP,et al.Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.Circulation,2015,131(10):861-870.
4.Johnston N,Jonelid B,Christersson C,et al.Effect of gender on patients with ST-Elevation and Non-ST-Elevation myocardialinfarction without obstructive coronary artery disease.Am J Cardiol,2015,115(12):1661-1666.
5.Najib K,Boateng S,Sangodkar S,et al.Incidence and characteristics of patients presenting with acute myocardial infarction and non-obstructive coronary artery disease.Catheter Cardiovasc Interv,2015,86(1):S23-S27.
6.Pasupathy S,Tavella R,Beltrame JF.Myocardial infarction with nonobstructive coronary arteries(MINOCA).Circulation,2017,135(16):1490-1493.
7.Yasue H,Nakagawa H,Itoh T,et al.Coronary artery spasm—Clinical features,diagnosis,pathogenesis,and treatment.J Cardiol,2008,51(1):2-17.
8.Beltrame JF,Crea F,Kaski JC,et al.The who,what,why,when,how and where of vasospastic angina.Circ J,2016,80(2):289-298.
9.Beltrame JF,Crea F,Kaski JC,et al.International standardization of diagnostic criteria for vasospastic angina.Eur Heart J,2017,38:2565-2568.
10.Bil J,Pietraszek N,Pawlowski T,et al.Advances in mechanisms and treatment options of MINOCA caused by vasospasm or microcirculation dysfunction.Curr Pharm Des,2017,23:1-15.
11.Reynolds HR,Srichai MB,Iqbal SN,et al.Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease.Circulation,2011,124(13):1414-1425.
12.Libby P,Pasterkamp G.Requiem for the'vulnerable plaque'.Eur Heart J,2015,36:2984-2987.
13.Poku N,Noble S.Myocardial infarction with non obstructive coronary arteries(MINOCA):A whole new ball game.Expert Rev of Cardiovase Ther,2017,15(1):7-14.
14.Kanwar SS,Stone GW,Singh M,et al.Acute coronary syndromes without coronary plaque rupture.Nat Rev Cardiol,2016,13(5):257-265.
15.Iqbal SN,Feit F,Mancini GBJ,et al.Characteristics of plaque disruption by intravascular ultrasound in women presenting with myocardial infarction without obstructive coronary artery disease.Am Heart J,2014,167(5):715-722.
16.Burke AP,Kolodgie FD,Farb A,et al.Morphological predictors of arterial remodeling in coronary atherosclerosis.Circulation,2002,105(3):297-303.
17.Moreno PR,Kini A.Resolution of Inflammation,Statins,and Plaque Regression,Editorials published in JACC:Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC:Cardiovascular Imaging or the American College of Cardiology.JACC:Cardiovasc Imaging,2012,5(2):178-181.
18.Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.J Am Coll of Cardiol,2013,62(19):1748-1758.
19.Kaitlyn E.Dugan AMRY.Calcified nodule as a cause of myocardial infarction with non-obstructive coronary artery disease.Int J Case Rep Images,2016,7(6):388-391.
20.Kardasz I,De Caterina R.Myocardial infarction with normal coronary arteries:A conundrum with multiple aetiologies and variable prognosis:An update.J Intern Med,2007,261(4):330-348.
21.Brolin EB,Brismar TB,Collste O,et al.Prevalence of myocardial bridging in patients with myocardial infarction and nonobstructed coronary arteries.Am J Cardiol,2015,116(12):1833-1839.
22.Alfonso F,Paulo M,Lennie V,et al.Spontaneous coronary artery dissection.JACC:Cardiovasc Interv,2012,5(10):1062-1070.
23.Tweet MS,Hayes SN,Pitta SR,et al.Clinical features,management,and prognosis of spontaneous coronary artery dissection.Circulation,2012,126(5):579-588.
24.Chen Cheng,Wei Janet,AlBadri Ahmed,et al.Coronary Microvascular Dysfunction—Epidemiology,Pathogenesis,Prognosis,Diagnosis,Risk Factors and Therapy.Circ J,2017,81(1):3-11.
25.Pacheco Claudio C,Quesada O,Pepine CJ,et al.Why namesmatter for women:MINOCA/INOCA(myocardial infarction/ischemia and no obstructive coronary artery disease).Clin Cardiol,2018,41(2):185-193.
26.Bairey Merz CN,Pepine CJ,Walsh MN,et al.Ischemia and no obstructive coronary artery disease(INOCA).Circulation,2017,135(11):1075-1092.
27.Chen C,Chang R,Chen C,et al.Takotsubo cardiomyopathy as an underlying mediator of myocardial infarction with normal coronary arteries.Cardiology,2010,115(3):186-190.
28.Lindsay J,Paixao A,Chao T,et al.Pathogenesis of the takotsubo syndrome:A unifying hypothesis.Am J Cardiol,2010,106(9):1360-1363.
29.Y-Hassan S,Tornvall P.Epidemiology,pathogenesis,and management of takotsubo syndrome.Clin Auton Res,2018,28(1):53-65.
30.Caforio ALP,Malipiero G,Marcolongo R,et al.Myocarditis:A clinical overview.Current Cardiology Reports,2017,19(7).
31.Tornvall P,Gerbaud E,Behaghel A,et al.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,2015,241(1):87-91.
32.Fedorov S,Kozlova I,Izhytska N,et al.Myocardial infarction with non-obstructive coronary arteries:Novelties and perspectives.The Pharma Innovation J,2017,6(9,Part H):527-529.
33.Shibata T,Kawakami S,Noguchi T,et al.Prevalence,clinical features,and prognosis of acute myocardial infarction attributable to coronary artery Embolism.Circulation,2015,132(4):241-250.
34.Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction.Eur Heart J,2012,33(20):2551-2567.
35.Pasupathy S,Tavella R,Beltrame JF.The what,when,who,why,how and where of myocardial infarction with Non-Obstructive coronary arteries(MINOCA).Circ J,2016,80(1):11-16.
36.Collste O,Sorensson P,Frick M,et al.Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging:Results from the Stockholm Myocardial Infarction with Normal Coronaries study.J Med,2013,273(2):189-196.
37.Ronnier J.AVILES ATAB.Troponin T levels in patients with acute coronary syndromes,with or without renal dysfunction.N Engl J Med,2002,346(26):2047-2052.
38.Leurent G,Langella B,Fougerou C,et al.Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin,acute chest pain syndrome and unobstructed coronary arteries.Arch Cardiovasc Dis,2011,104(3):161-170.
39.Ouldzein H,Elbaz M,Roncalli J,et al.Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion:Analysis by intravascular ultrasound.An Cardiol Angeiol,2012,61(1):20-26.
40.Yoshimura S,Kawasaki M,Yamada K,et al.Visualization of internal carotid artery atherosclerotic plaques in symptomatic and asymptomatic patients:A comparison of optical coherence tomography and intravascular ultrasound.Am J Neuroradiol,2012,33(2):308-313.
41.Miyamoto Y,Okura H,Kume T,et al.Plaque characteristics ofThin-Cap fibroatheroma evaluated by OCT and IVUS.JACC:Cardiovasc Imaging,2011,4(6):638-646.
42.Montone RA,Niccoli G,Fracassi F,et al.Patients with acute myocardial infarction and non-obstructive coronary arteries:Safety and prognostic relevance of invasive coronary provocative tests.Eur Heart J,2018,39:91-98.
43.Da Costa A.Clinical characteristics,aetiological factors and longterm prognosis of myocardial infarction with an absolutely normal coronary angiogram;A 3-year follow-up study of 91 patients,Eur Heart J,2001,22(16):1459-1465.
44.Dacosta A,Tardy-Poncet B,Isaaz K,et al.Prevalence of factor V Leiden(APCR)and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries.Heart,1998,80(4):33 8-340.
45.Kang WY,Jeong MH,Ahn YK,et al.Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe?Int J Cardiol.2011,146(2):207-212.
46.Grodzinsky A,Arnold SV,Gosch K,et al.Angina frequency after acute myocardial infarction in patients without obstructivecoronary artery disease.Eur Heart J Qual Care Clin Outcomes,2015,l(2):92-99.
47.Pathik B,Raman B,Mohd Amin NH,et al.Troponin-positive chest pain with unobstructed coronary arteries:Incremental diagnostic value of cardiovascular magnetic resonance imaging.Eur Heart J Cardiovasc Imaging,2016,17(10):1146-1152.
48.Lindahl B,Baron T,Erlinge D,et al.Medical therapy for secondary prevention and Long-Term outcome in patients with myocardial infarction with nonobstructive coronary artery Disease.Circulation,2017,135(16):1481-1489.
49.Smilowitz NR,Mahajan AM,Roe MT,et al.Mortality of myocardial infarction by sex,age,and obstructive coronary artery disease status in Qual Outcomes,2017,10(12):e3443.
50.Pais JL,Izquiethe ACTION registry-GWTG(Acute coronary treatment and intervention outcomes network registry-get with the guidelines).Circ:Cardiovasc rdo Coronel B,Galan Gil D,et al.Psychoemotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries.Cardiol J,2018,25(1):24-31.
2.Beltrame JF.Assessing patients with myocardial infarction and nonobstructed coronary arteries(MINOCA).J Med,2013,273(2):182-185.
3.Pasupathy S,Air T,Dreyer RP,et al.Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.Circulation,2015,131(10):861-870.
4.Johnston N,Jonelid B,Christersson C,et al.Effect of gender on patients with ST-Elevation and Non-ST-Elevation myocardialinfarction without obstructive coronary artery disease.Am J Cardiol,2015,115(12):1661-1666.
5.Najib K,Boateng S,Sangodkar S,et al.Incidence and characteristics of patients presenting with acute myocardial infarction and non-obstructive coronary artery disease.Catheter Cardiovasc Interv,2015,86(1):S23-S27.
6.Pasupathy S,Tavella R,Beltrame JF.Myocardial infarction with nonobstructive coronary arteries(MINOCA).Circulation,2017,135(16):1490-1493.
7.Yasue H,Nakagawa H,Itoh T,et al.Coronary artery spasm—Clinical features,diagnosis,pathogenesis,and treatment.J Cardiol,2008,51(1):2-17.
8.Beltrame JF,Crea F,Kaski JC,et al.The who,what,why,when,how and where of vasospastic angina.Circ J,2016,80(2):289-298.
9.Beltrame JF,Crea F,Kaski JC,et al.International standardization of diagnostic criteria for vasospastic angina.Eur Heart J,2017,38:2565-2568.
10.Bil J,Pietraszek N,Pawlowski T,et al.Advances in mechanisms and treatment options of MINOCA caused by vasospasm or microcirculation dysfunction.Curr Pharm Des,2017,23:1-15.
11.Reynolds HR,Srichai MB,Iqbal SN,et al.Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease.Circulation,2011,124(13):1414-1425.
12.Libby P,Pasterkamp G.Requiem for the'vulnerable plaque'.Eur Heart J,2015,36:2984-2987.
13.Poku N,Noble S.Myocardial infarction with non obstructive coronary arteries(MINOCA):A whole new ball game.Expert Rev of Cardiovase Ther,2017,15(1):7-14.
14.Kanwar SS,Stone GW,Singh M,et al.Acute coronary syndromes without coronary plaque rupture.Nat Rev Cardiol,2016,13(5):257-265.
15.Iqbal SN,Feit F,Mancini GBJ,et al.Characteristics of plaque disruption by intravascular ultrasound in women presenting with myocardial infarction without obstructive coronary artery disease.Am Heart J,2014,167(5):715-722.
16.Burke AP,Kolodgie FD,Farb A,et al.Morphological predictors of arterial remodeling in coronary atherosclerosis.Circulation,2002,105(3):297-303.
17.Moreno PR,Kini A.Resolution of Inflammation,Statins,and Plaque Regression,Editorials published in JACC:Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC:Cardiovascular Imaging or the American College of Cardiology.JACC:Cardiovasc Imaging,2012,5(2):178-181.
18.Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.J Am Coll of Cardiol,2013,62(19):1748-1758.
19.Kaitlyn E.Dugan AMRY.Calcified nodule as a cause of myocardial infarction with non-obstructive coronary artery disease.Int J Case Rep Images,2016,7(6):388-391.
20.Kardasz I,De Caterina R.Myocardial infarction with normal coronary arteries:A conundrum with multiple aetiologies and variable prognosis:An update.J Intern Med,2007,261(4):330-348.
21.Brolin EB,Brismar TB,Collste O,et al.Prevalence of myocardial bridging in patients with myocardial infarction and nonobstructed coronary arteries.Am J Cardiol,2015,116(12):1833-1839.
22.Alfonso F,Paulo M,Lennie V,et al.Spontaneous coronary artery dissection.JACC:Cardiovasc Interv,2012,5(10):1062-1070.
23.Tweet MS,Hayes SN,Pitta SR,et al.Clinical features,management,and prognosis of spontaneous coronary artery dissection.Circulation,2012,126(5):579-588.
24.Chen Cheng,Wei Janet,AlBadri Ahmed,et al.Coronary Microvascular Dysfunction—Epidemiology,Pathogenesis,Prognosis,Diagnosis,Risk Factors and Therapy.Circ J,2017,81(1):3-11.
25.Pacheco Claudio C,Quesada O,Pepine CJ,et al.Why namesmatter for women:MINOCA/INOCA(myocardial infarction/ischemia and no obstructive coronary artery disease).Clin Cardiol,2018,41(2):185-193.
26.Bairey Merz CN,Pepine CJ,Walsh MN,et al.Ischemia and no obstructive coronary artery disease(INOCA).Circulation,2017,135(11):1075-1092.
27.Chen C,Chang R,Chen C,et al.Takotsubo cardiomyopathy as an underlying mediator of myocardial infarction with normal coronary arteries.Cardiology,2010,115(3):186-190.
28.Lindsay J,Paixao A,Chao T,et al.Pathogenesis of the takotsubo syndrome:A unifying hypothesis.Am J Cardiol,2010,106(9):1360-1363.
29.Y-Hassan S,Tornvall P.Epidemiology,pathogenesis,and management of takotsubo syndrome.Clin Auton Res,2018,28(1):53-65.
30.Caforio ALP,Malipiero G,Marcolongo R,et al.Myocarditis:A clinical overview.Current Cardiology Reports,2017,19(7).
31.Tornvall P,Gerbaud E,Behaghel A,et al.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,2015,241(1):87-91.
32.Fedorov S,Kozlova I,Izhytska N,et al.Myocardial infarction with non-obstructive coronary arteries:Novelties and perspectives.The Pharma Innovation J,2017,6(9,Part H):527-529.
33.Shibata T,Kawakami S,Noguchi T,et al.Prevalence,clinical features,and prognosis of acute myocardial infarction attributable to coronary artery Embolism.Circulation,2015,132(4):241-250.
34.Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction.Eur Heart J,2012,33(20):2551-2567.
35.Pasupathy S,Tavella R,Beltrame JF.The what,when,who,why,how and where of myocardial infarction with Non-Obstructive coronary arteries(MINOCA).Circ J,2016,80(1):11-16.
36.Collste O,Sorensson P,Frick M,et al.Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging:Results from the Stockholm Myocardial Infarction with Normal Coronaries study.J Med,2013,273(2):189-196.
37.Ronnier J.AVILES ATAB.Troponin T levels in patients with acute coronary syndromes,with or without renal dysfunction.N Engl J Med,2002,346(26):2047-2052.
38.Leurent G,Langella B,Fougerou C,et al.Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin,acute chest pain syndrome and unobstructed coronary arteries.Arch Cardiovasc Dis,2011,104(3):161-170.
39.Ouldzein H,Elbaz M,Roncalli J,et al.Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion:Analysis by intravascular ultrasound.An Cardiol Angeiol,2012,61(1):20-26.
40.Yoshimura S,Kawasaki M,Yamada K,et al.Visualization of internal carotid artery atherosclerotic plaques in symptomatic and asymptomatic patients:A comparison of optical coherence tomography and intravascular ultrasound.Am J Neuroradiol,2012,33(2):308-313.
41.Miyamoto Y,Okura H,Kume T,et al.Plaque characteristics ofThin-Cap fibroatheroma evaluated by OCT and IVUS.JACC:Cardiovasc Imaging,2011,4(6):638-646.
42.Montone RA,Niccoli G,Fracassi F,et al.Patients with acute myocardial infarction and non-obstructive coronary arteries:Safety and prognostic relevance of invasive coronary provocative tests.Eur Heart J,2018,39:91-98.
43.Da Costa A.Clinical characteristics,aetiological factors and longterm prognosis of myocardial infarction with an absolutely normal coronary angiogram;A 3-year follow-up study of 91 patients,Eur Heart J,2001,22(16):1459-1465.
44.Dacosta A,Tardy-Poncet B,Isaaz K,et al.Prevalence of factor V Leiden(APCR)and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries.Heart,1998,80(4):33 8-340.
45.Kang WY,Jeong MH,Ahn YK,et al.Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe?Int J Cardiol.2011,146(2):207-212.
46.Grodzinsky A,Arnold SV,Gosch K,et al.Angina frequency after acute myocardial infarction in patients without obstructivecoronary artery disease.Eur Heart J Qual Care Clin Outcomes,2015,l(2):92-99.
47.Pathik B,Raman B,Mohd Amin NH,et al.Troponin-positive chest pain with unobstructed coronary arteries:Incremental diagnostic value of cardiovascular magnetic resonance imaging.Eur Heart J Cardiovasc Imaging,2016,17(10):1146-1152.
48.Lindahl B,Baron T,Erlinge D,et al.Medical therapy for secondary prevention and Long-Term outcome in patients with myocardial infarction with nonobstructive coronary artery Disease.Circulation,2017,135(16):1481-1489.
49.Smilowitz NR,Mahajan AM,Roe MT,et al.Mortality of myocardial infarction by sex,age,and obstructive coronary artery disease status in Qual Outcomes,2017,10(12):e3443.
50.Pais JL,Izquiethe ACTION registry-GWTG(Acute coronary treatment and intervention outcomes network registry-get with the guidelines).Circ:Cardiovasc rdo Coronel B,Galan Gil D,et al.Psychoemotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries.Cardiol J,2018,25(1):24-31.