Mechanisms of non-obstructed myocardial infarction in women

January 01, 0001

Mechanisms of non-obstructed myocardial infarction in women

An important minority of patients with myocardial infarction, often women, have no obstruction on angiography. These US and Canadian researchers used multiple imaging technologies to elucidate the the mechanism(s) of infarction in such cases. Women were enrolled in the study prior to angiography and those =50% stenosis and those on vasospastic agents were excluded. They performed intravascular ultrasound during the angiography and cardiac magnetic resonance imaging was subsequently performed.

The researchers found: "Fifty women (age, 57±13 years) had median peak troponin of 1.60 ng/mL and 11 had ST-segment elevation. Median diameter stenosis of the worst lesion was 20% by angiography. Fifteen patients (30%) had normal angiograms. Plaque disruption was observed in 16 of 42 patients (38%) undergoing intravascular ultrasound. There were abnormal myocardial cardiac magnetic resonance imaging findings in 26 of 44 patients (59%) undergoing cardiac magnetic resonance imaging, late gadolinium enhancement (LGE) in 17 patients, and T2 signal hyperintensity indicating edema in 9 additional patients. The most common LGE pattern was ischemic (transmural/subendocardial). Nonischemic LGE patterns (midmyocardial/subepicardial) were also observed. Although LGE was infrequent with plaque disruption, T2 signal hyperintensity was common with plaque disruption."

The researchers concluded: "Plaque rupture and ulceration are common in women with myocardial infarction without angiographically demonstrable obstructive coronary artery disease. In addition, LGE is common in this cohort of women, with an ischemic pattern of injury most evident. Vasospasm and embolism are possible mechanisms of ischemic LGE without plaque disruption. Intravascular ultrasound and cardiac magnetic resonance imaging provide complementary mechanistic insights into female myocardial infarction patients without obstructive coronary artery disease and may be useful in identifying potential causes and therapies."

This study sheds important light on the mechanisms of myocardial infarction in the absence of obstructive coronary artery disease

For the full abstract, click here.

Circulation 124(13):1414-1425, 27 September 2011 © 2011 American Heart Association, Inc.
Mechanisms of Myocardial Infarction in Women Without Angiographically Obstructive Coronary Artery Disease. Harmony R. Reynolds, Monvadi B. Srichai, Sohah N. Iqbal, et al. Correspondence to Harmony R. Reynolds: Harmony.Reynolds@NYUMC.org

Category: K. Circulatory. Keywords: myocardial infarction, women, non-obstructive, ultrasound, magnetic resonance imaging, epidemiological study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care