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Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography

BACKGROUND: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA...

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Autores principales: Panayi, Georgios, Wieringa, Wouter G., Alfredsson, Joakim, Carlsson, Jörg, Karlsson, Jan-Erik, Persson, Anders, Engvall, Jan, Pundziute, Gabija, Swahn, Eva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855362/
https://www.ncbi.nlm.nih.gov/pubmed/27142217
http://dx.doi.org/10.1186/s12872-016-0254-y
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author Panayi, Georgios
Wieringa, Wouter G.
Alfredsson, Joakim
Carlsson, Jörg
Karlsson, Jan-Erik
Persson, Anders
Engvall, Jan
Pundziute, Gabija
Swahn, Eva
author_facet Panayi, Georgios
Wieringa, Wouter G.
Alfredsson, Joakim
Carlsson, Jörg
Karlsson, Jan-Erik
Persson, Anders
Engvall, Jan
Pundziute, Gabija
Swahn, Eva
author_sort Panayi, Georgios
collection PubMed
description BACKGROUND: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. METHODS: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. RESULTS: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. CONCLUSIONS: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0254-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-48553622016-05-05 Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography Panayi, Georgios Wieringa, Wouter G. Alfredsson, Joakim Carlsson, Jörg Karlsson, Jan-Erik Persson, Anders Engvall, Jan Pundziute, Gabija Swahn, Eva BMC Cardiovasc Disord Research Article BACKGROUND: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. METHODS: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. RESULTS: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. CONCLUSIONS: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0254-y) contains supplementary material, which is available to authorized users. BioMed Central 2016-05-03 /pmc/articles/PMC4855362/ /pubmed/27142217 http://dx.doi.org/10.1186/s12872-016-0254-y Text en © Panayi et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Panayi, Georgios
Wieringa, Wouter G.
Alfredsson, Joakim
Carlsson, Jörg
Karlsson, Jan-Erik
Persson, Anders
Engvall, Jan
Pundziute, Gabija
Swahn, Eva
Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title_full Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title_fullStr Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title_full_unstemmed Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title_short Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
title_sort computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855362/
https://www.ncbi.nlm.nih.gov/pubmed/27142217
http://dx.doi.org/10.1186/s12872-016-0254-y
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