PMID- 21900087
OWN - NLM
STAT- MEDLINE
DCOM- 20111121
LR  - 20220331
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 124
IP  - 13
DP  - 2011 Sep 27
TI  - Mechanisms of myocardial infarction in women without angiographically obstructive 
      coronary artery disease.
PG  - 1414-25
LID - 10.1161/CIRCULATIONAHA.111.026542 [doi]
AB  - BACKGROUND: There is no angiographically demonstrable obstructive coronary artery 
      disease (CAD) in a significant minority of patients with myocardial infarction, 
      particularly women. We sought to determine the mechanism(s) of myocardial 
      infarction in this setting using multiple imaging techniques. METHODS AND 
      RESULTS: Women with myocardial infarction were enrolled prospectively, before 
      angiography, if possible. Women with >/=50% angiographic stenosis or use of 
      vasospastic agents were excluded. Intravascular ultrasound was performed during 
      angiography; cardiac magnetic resonance imaging was performed within 1 week. 
      Fifty women (age, 57+/-13 years) had median peak troponin of 1.60 ng/mL; 11 had 
      ST-segment elevation. Median diameter stenosis of the worst lesion was 20% by 
      angiography; 15 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. CONCLUSIONS: 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. Clinical 
      Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: 
      NCT00798122.
FAU - Reynolds, Harmony R
AU  - Reynolds HR
AD  - Cardiovascular Clinical Research Center, 530 First Ave SKI-9R, New York, NY 
      10016, USA. Harmony.Reynolds@NYUMC.org
FAU - Srichai, Monvadi B
AU  - Srichai MB
FAU - Iqbal, Sohah N
AU  - Iqbal SN
FAU - Slater, James N
AU  - Slater JN
FAU - Mancini, G B John
AU  - Mancini GB
FAU - Feit, Frederick
AU  - Feit F
FAU - Pena-Sing, Ivan
AU  - Pena-Sing I
FAU - Axel, Leon
AU  - Axel L
FAU - Attubato, Michael J
AU  - Attubato MJ
FAU - Yatskar, Leonid
AU  - Yatskar L
FAU - Kalhorn, Rebecca T
AU  - Kalhorn RT
FAU - Wood, David A
AU  - Wood DA
FAU - Lobach, Iryna V
AU  - Lobach IV
FAU - Hochman, Judith S
AU  - Hochman JS
LA  - eng
SI  - ClinicalTrials.gov/NCT00798122
GR  - M01 RR000096/RR/NCRR NIH HHS/United States
GR  - UL1 RR029893/RR/NCRR NIH HHS/United States
GR  - 1UL1RR029893/RR/NCRR NIH HHS/United States
GR  - M01RR0096/RR/NCRR NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20110906
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
CIN - Circulation. 2011 Sep 27;124(13):1404-6. PMID: 21947933
CIN - Circulation. 2012 Aug 7;126(6):e81; author reply e83. PMID: 22869863
CIN - Circulation. 2012 Aug 7;126(6):e82; author reply e83. PMID: 22869864
MH  - Adult
MH  - Aged
MH  - Coronary Angiography
MH  - Coronary Artery Disease/complications/diagnosis
MH  - Coronary Vasospasm/complications/diagnosis
MH  - Electrocardiography
MH  - Embolism/complications/diagnosis
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis/*etiology
MH  - Myocardial Ischemia/*complications/*diagnosis
MH  - Plaque, Atherosclerotic/complications/diagnosis
MH  - Prospective Studies
MH  - Takotsubo Cardiomyopathy/complications/diagnosis
MH  - Ultrasonography, Interventional
PMC - PMC3619391
MID - NIHMS434274
COIS- Conflict of Interest Disclosures: none
EDAT- 2011/09/09 06:00
MHDA- 2011/12/13 00:00
PMCR- 2013/04/08
CRDT- 2011/09/09 06:00
PHST- 2011/09/09 06:00 [entrez]
PHST- 2011/09/09 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
PHST- 2013/04/08 00:00 [pmc-release]
AID - CIRCULATIONAHA.111.026542 [pii]
AID - 10.1161/CIRCULATIONAHA.111.026542 [doi]
PST - ppublish
SO  - Circulation. 2011 Sep 27;124(13):1414-25. doi: 10.1161/CIRCULATIONAHA.111.026542. 
      Epub 2011 Sep 6.