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Advanced Diagnostic Imaging in Patients With MINOCA
Quick Takes
- A select group of MINOCA patients with ECG and corresponding echo evidence of ischemia underwent OCT and CMR in this study.
- CMR and OCT findings led to a diagnosis/cause of MINOCA in all patients.
- Whether routine use of these modalities in select MINOCA patients leads to improved clinical outcomes remains to be determined and warrants further study.
Study Questions:
What is the diagnostic yield of intravascular optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) among patients with electrocardiogram (ECG) and regional wall motion evidence of myocardial infarction with nonobstructive coronary arteries (MINOCA)?
Methods:
In a prospective two-center study, consecutive patients with MINOCA including ECG features of ischemia associated with corresponding wall motion abnormalities (WMAs) underwent OCT and CMR.
Results:
Forty patients (mean age 50 ± 11 years, 62.5% male, 32.5% with ST-segment elevation) were enrolled. Coronary arteries were normal on coronary angiography in 10 patients (25%); 18 patients (45%) presented minimal lumen irregularities, whereas the remaining 12 patients (30%) showed mild to moderate (≥30% but ≤50%) coronary lesions. Plaque rupture, eruptive calcific nodule, plaque erosion, lone thrombus, and spontaneous coronary artery dissection were found in 14 (35%), one (2.5%), 12 (30%), three (7.5%), and two (5%) patients, respectively. Acute myocardial infarction was evident at CMR in 31 of 40 patients (77.5%). Twenty-three patients (57.5%) had a substrate and/or diagnosis supported by both techniques with an evident relationship between the findings obtained by the two techniques. By coupling OCT with CMR, a substrate and/or diagnosis was found in 100% of cases.
Conclusions:
OCT coupled with CMR can provide a clear substrate and/or diagnosis in the vast majority of patients presenting with MINOCA including ECG features of ischemia associated with corresponding WMAs.
Perspective:
MINOCA remains an important and challenging diagnosis to manage and treat. This study furthers our understanding of MINOCA by reporting on a select group of MINOCA patients who had ECG and echo evidence of WMA to suggest coronary pathology. In this select group, use of OCT and CMR confirmed a diagnosis in all patients. MINOCA remains heterogenous in presentation and use of multimodality imaging such as CMR and OCT appears to be important in confirming cause of myocardial infarction without obstructive coronary artery disease. Whether routine use of these modalities in select MINOCA patients leads to improved clinical outcomes remains to be determined and warrants further study.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Coronary Angiography, Coronary Artery Disease, Coronary Vessel Anomalies, Diagnostic Imaging, Echocardiography, Electrocardiography, Magnetic Resonance Imaging, Myocardial Infarction, Ischemia, Plaque, Atherosclerotic, Thrombosis, Tomography, Optical Coherence, Vascular Diseases
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