RETROSPECTIVE STUDY OF EVALUATION OF PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION AND INTACT CORONARY ARTERIES. EVALUATION OF TREATMENT APPROACHES; OUTCOME AND PROGNOSIS.

Myocardial infarction with normal coronary arteries is a well known pathology. It may or may not be associated with left ventricle wall motion abnormalities. Data was reviewed retrospectively for patients with ST elevation myocardial infarction who underwent cardiac catheterization. From the total number of patients evaluated 10.3% (17) patients had Myocardial Infarction with normal coronary arteries. Females were more likely to present with MINCA then males. Coronary flow was normal in 11 from 17 patients with MINCA. In 6 cases slow coronary flow was detected. Myocardial segments with slow coronary flow did not correlate with wall motion abnormalities detected by echocardiography and ventriculography. In 8 females, Takotsubo cardiomyopathy was suspected. Data were analyzed retrospectively and we were not able to obtain full coagulation panel for all evaluated patients. Myocardial biopsy was not performed in either of patients under observation. Spontaneous thrombolysis was suspected in number of cases. Most angiography investigations were done within three hours after symptoms start. Prognosis of patients with ST-elevation Myocardial Infarction (STEMI) and normal coronary arteries was good. No fatal or non-fatal complications during hospitalization. During 6 month, follow up one male patient was re-hospitalized due to Acute Coronary Syndrome (ACS) in 5.5 month after initial event. Repeated coronary angiography did not reveal the abnormalities. Our study is first attempt for collecting retrospectively different data for patients with STEMI and NCA. Important is that no correlation was found between wall motion abnormalities and coronary flow limitations (if present). Compared to other studies we found higher incidences of wall motion abnormalities detected by echocardiography and/or ventriculography. Future prospective design studies in STEMI and NCA are warranted to understand the pathophysiology and define right treatment approaches. Stress may be considered as prominent factor, but future studies are needed with psychological evaluation; autonomous nerves system testing and catecholamine levels determination to verify its role in this pathology.