• Pabla Cataldo V, Fernando J Verdugo, Christian Dauvergne, Alfonso García, Pablo Antileo, Rodrigo Monsalve, Fernando Pineda, Manuel Méndez, Polentzi Uriarte, Mario Araya H, Pedro Llerena, Yalile Nauhm, Gonzalo Pereira, Cristóbal Ramos, Marco Coello V, Christian Garrido G, Tomas Delgado A, Soledad González, and Jorge Sandoval B.
• Departamento de Cardiología, Instituto Nacional del Tórax, Unidad de Cardiología Intervencional y Hemodinamia, Santiago, Chile.
• Rev Med Chil. 2020 Aug 1; 148 (8): 1083-1089.

BackgroundMyocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology.AimTo describe a population with MINOCA and its multi-image assessment using IVI or CMR.Material And MethodsReview of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019.ResultsTwenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died.ConclusionsAmong patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

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