Abstract 2392: Myocardial Infarction With Normal Coronary Arteries - a Current Perspective

Background: Myocardial infarction with normal coronary arteries (MINCA) has been recognized for many years, with a prevalence of 1 to 12% depending on the patient population. Various pathophysiologic mechanisms have been hypothesized, mainly coronary artery spasm and coagulation disorders. Most studies, however, were retrospective and not all patients had undergone emergency coronary angiography. This study sought to define prevalence and presumed mechanisms of MINCA in the era of emergency PCI by applying current criteria and modern diagnostic tools. Methods and Results: Over a 2.5-year period, 63 MINCA were prospectively identified among 1081 patients with an acute coronary syndrome (ACS) undergoing emergency coronary angiography (prevalence 5.8%, 41 f, 22 m, age 65±15 years). MINCA was significantly more common in females (41/352 (11.6%) vs 22/729 (3.0%), p Conclusion: MINCA occurs in 6% of patients with ACS undergoing emergency coronary angiography and is significantly more common in elderly females. Contrary to previous reports, coronary artery spasm and coagulopathies appear to be rare. Tako-tsubo-CMP and myocarditis, from a current perspective, represent the most frequent MINCA mechanisms.