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Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

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Abstract

The study is aimed at evaluating the real incidence of normal coronary arteries and the role of alternative substrates of myocardial ischemia in patients with acute coronary syndrome (ACS) but with no coronary artery disease (CAD) in a real world secondary care public hospital. The medical records of 941 patients undergoing coronary arteriography for ACS within 48 h of onset between January 1st 2000 and November 1st 2003 were critically reviewed. In 70 patients (7.4%, 35 males, mean age 60 ± 17.2 years) no CAD was documented. Alternative substrates of acute myocardial ischemia included coronary artery anomalies (7 patients, 10%), coronary spasm (10 patients, 14.3%), spontaneous coronary dissection (2 patients, 2.8%), paradoxical embolism through a patent foramen ovale (4 patients, 5.7%), embolism from left atrium or calcified aortic valve (4 patients, 5.7%), imbalance between oxygen demand and supply (20 patients, 28.5%), mitral valve prolapse (11 patients, 15.7%). No alternative substrates were found in 12 patients (17.1%). Patients with no CAD are more frequently female and younger. Absence of CAD is an uncommon finding in patients undergoing coronary artery angiography for ACS.

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References

  • P Amman S Marshall M Kraus et al. (2000) ArticleTitleCharacteristic and prognosis of myocardial infarction in patients with normal coronary arteries Chest 117 333–338

    Google Scholar 

  • Costa A Da K Isaaz E Faure S Mourot A Cerisier M Lamaud (2001) ArticleTitleClinical characteristics, aethiological factors and long term prognosis of myocardial infarction with an absolutely normal coronary angiogram – a 3-year follow-up study of 91 patients Eur Heart J 22 1459–1465

    Google Scholar 

  • ME Bertrand ML Simoons KAA Fox et al. (2002) ArticleTitleManagement of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation Eur Heart J 23 1809–1840 Occurrence Handle10.1053/euhj.2002.3385 Occurrence Handle12503543

    Article  PubMed  Google Scholar 

  • F Werf ParticleVan de D Ardissino A Betriu et al. (2003) ArticleTitleManagement of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 24 28–66

    Google Scholar 

  • P Angelini (2002) ArticleTitleCoronary artery anomalies – current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines Tex Heart I J 29 271–278

    Google Scholar 

  • EL Alderman M Stadius (1992) ArticleTitleThe angiographic definitions of the bypass angioplasty revascularization investigation Coron Artery Dis 3 1189–1207

    Google Scholar 

  • MA Nedeljkovic M Ostojic B Beleslin et al. (2001) ArticleTitleEfficiency of ergonovine echocardiography in detecting angiographically assessed coronary vasospasm Am J Cardiol 88 1183–1187 Occurrence Handle11703968 Occurrence Handle1:STN:280:DC%2BD3MnltF2ksA%3D%3D

    PubMed  CAS  Google Scholar 

  • DE Wachsman AK Jacobs (2003) ArticleTitleParadoxical coronary embolism: a rare cause of acute myocardial infarction Rev Cardiovasc Med 4 107–111 Occurrence Handle12776018

    PubMed  Google Scholar 

  • R Crump AH Shanding B Natta ParticleVan M Ellestad (2000) ArticleTitlePrevalence of patent foramen ovale in patients with acute myocardial infarction and angiographically normal coronary arteries Am J Cardiol 85 1368–1370 Occurrence Handle10831957 Occurrence Handle1:STN:280:DC%2BD3c3pt1OhsA%3D%3D

    PubMed  CAS  Google Scholar 

  • Steiner MK, Clarkson PB, Lip GY. Myocardial infarction complicating hormone replacement therapy in a young woman with normal coronary arteries.

  • M Kyriadis A Androulakis F Triposkiadis et al. (1995) ArticleTitleLack of thrombotic tendency in patients with acute myocardial infarction and angiographically normal coronary arteries Cardiology 86 22–24 Occurrence Handle10.1159/000176825

    Article  Google Scholar 

  • DH Israel W Sherman SK Sharma MR Estioko JA Ambrose (1990) ArticleTitleAortic valve tumor: an unusual cause of coronary obstruction during cardiac catheterization Catheter Cardio Diag 20 48–50 Occurrence Handle1:STN:280:By%2BB28zgslc%3D

    CAS  Google Scholar 

  • F Shamsham AM Safi I Pomerenko et al. (2000) ArticleTitleFatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization Catheter Cardiovasc Interv. 50 74–77 Occurrence Handle10816286 Occurrence Handle1:STN:280:DC%2BD3c3ns1GqtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • MS Aslam V Sanghi S Hersh JB Lakier (2002) ArticleTitleCoronary artery saddle embolus and myocardial infarction in a patient with prosthetic mitral valve Catheter Cardiovasc Interv 57 367–370 Occurrence Handle12410516

    PubMed  Google Scholar 

  • F Voss HB Bludau C Haller (2003) ArticleTitleMitral valve endocarditis: an uncommon cause of myocardial infarction Z Kardiol 92 686–688 Occurrence Handle14579847 Occurrence Handle1:STN:280:DC%2BD3srgt1eltQ%3D%3D

    PubMed  CAS  Google Scholar 

  • C Yutani M Imakita H Ueda-Ishibashi M Katsuragi H Fujita (1992) ArticleTitleCoronary artery embolism with special reference of invasive procedures as the source Mod Pathol 5 244–249 Occurrence Handle1495930 Occurrence Handle1:STN:280:By2A2MjmsVw%3D

    PubMed  CAS  Google Scholar 

  • JR Doty RE Wilentz JD Salazar RH Hruban DE Cameron (2003) ArticleTitleAtheroembolism in cardiac surgery Ann Thorac Surg 75 1221–1226 Occurrence Handle12683567

    PubMed  Google Scholar 

  • T Timurkaynak G Aydogdu A Cengel (2002) ArticleTitleAcute myocardial infarction secondary to thyrotoxicosis Acta Cardiol 57 439–442 Occurrence Handle12542124

    PubMed  Google Scholar 

  • S Gorgulu S Celik T Tezel (2002) ArticleTitleA case of coronary spasm induced by 5-fluorouracil Acta Cardiol 57 381–383 Occurrence Handle12405579

    PubMed  Google Scholar 

  • MY Yu RL Gao JL Chen et al. (2003) ArticleTitleComplications in selective percutaneous coronary interventions: analysis of 2,868 cases Zhonghua Nei Ke Za Zhi 42 550–553 Occurrence Handle14505545

    PubMed  Google Scholar 

  • RK Mautner MD Cooper JH Phillips (1983) ArticleTitleCatheter-induced coronary artery spasm: an angiographic manifestation of vasospastic angina? Am Heart J 106 659–665 Occurrence Handle6613809 Occurrence Handle1:STN:280:BiyA3crksV0%3D

    PubMed  CAS  Google Scholar 

  • PA Majid JB Cheirif R Rokey et al. (1992) ArticleTitleDoes cocaine cause coronary vasospasm in chronic cocaine abusers? A study of coronary and systemic hemodynamics. Clin Cardiol 15 253–258 Occurrence Handle1:STN:280:By2B38vksFI%3D

    CAS  Google Scholar 

  • RF Kelly V Sompalli P Sattar K Khankari (2003) ArticleTitleIncreased TIMI frame counts in cocaine users: a case for increased microvascular resistance in the absence of epicardial coronary disease or spasm Clin Cardiol 26 319–322 Occurrence Handle12862297

    PubMed  Google Scholar 

  • AV Mattioli L Bonetti M Aquilina et al. (2003) ArticleTitleThe association between atrial septal aneurysm and mitral valve prolapse in patients with recent stroke and normal carotid arteries Ital Heart J 4 602–606 Occurrence Handle14635377

    PubMed  Google Scholar 

  • D Playford AE Weyman (2001) ArticleTitleMitral valve prolapse: time for a fresh look Rev Cardiovasc Med 2 73–81 Occurrence Handle12439384 Occurrence Handle1:STN:280:DC%2BD38nnvV2ktQ%3D%3D

    PubMed  CAS  Google Scholar 

  • G Rigatelli G Docali P Rossi et al. (2003) ArticleTitleCongenital coronary artery anomalies angiographic classification revisited Int J Cardiovasc Imaging 19 361–366 Occurrence Handle14609183

    PubMed  Google Scholar 

  • Rigatelli G, Docali G, Rossi P, Bovolon D, Rossi D, Rigatelli G. Validation of a new clinical significance-based classification of congenital coronary artery anomalies. Angiology (in press).

  • Gl Rigatelli G Rigatelli (2003) ArticleTitleCoronary artery anomalies: what we know and what we have to learn A proposal for a new clinical classification. Ital Heart J 4 305–310

    Google Scholar 

  • P Angelini JA Velasco D Ott GR Khoshnevis (2003) ArticleTitleAnomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography J Invasive Cardiol 15 507–514 Occurrence Handle12947211

    PubMed  Google Scholar 

  • A Berenguer V Mainar P Bordes J Valencia V Arrarte (2003) ArticleTitleSpontaneous coronary artery dissection An infrequent cause of acute coronary syndromes. Rev Esp Cardiol. 56 1017–1021

    Google Scholar 

  • R Kamineni A Sadhu JS Alpert (2002) ArticleTitleSpontaneous coronary artery dissection: report of two cases and a 50-year review of the literature Cardiol Rev 10 279–284 Occurrence Handle12215191

    PubMed  Google Scholar 

  • E Nikolsky M Boulos S. Amikam (2003) ArticleTitleSpontaneous healing of long, catheter-induced right coronary artery dissection Int J Cardiovasc Intervent 5 211 Occurrence Handle14630565

    PubMed  Google Scholar 

  • HA Mohamed A Eshawesh N Habib (2002) ArticleTitleSpontaneous coronary artery dissection – a case report and review of the literature Angiology 53 205–211 Occurrence Handle11952112 Occurrence Handle10.1177/000331970205300212

    Article  PubMed  Google Scholar 

  • A Iyisoy H Kursaklioglu S Kose C Ozturk B Amasyali E Demirtas (2003) ArticleTitleSpontaneous intimal dissection in a patient with post-infarct angina: identification with intravascular ultrasound and treatment with coronary stenting Jpn Heart J 44 557–564 Occurrence Handle12906037

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Endo Cardio Vascular Therapy Research, Via Cilea 7, 37040, Legnago, Verona, Italy

    Gianluca Rigatelli & Giorgio Rigatelli

  2. Department of Specialist Medicine, Division of Cardiology, ‘Mater Salutis’ Legnago General Hospital, Verona, Italy

    Giorgio Rigatelli, Paolo Rossi & Giorgio Docali

Authors
  1. Gianluca Rigatelli
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  2. Giorgio Rigatelli
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  3. Paolo Rossi
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  4. Giorgio Docali
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Correspondence to Giorgio Rigatelli.

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Rigatelli, G., Rigatelli, G., Rossi, P. et al. Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia. Int J Cardiovasc Imaging 20, 471–475 (2004). https://doi.org/10.1007/s10554-004-1924-x

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  • DOI: https://doi.org/10.1007/s10554-004-1924-x

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