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Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
University of Groningen, Netherlands.
Linköping University, Department of Medical and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
Kalmar County Hospital, Sweden; Linnaeus University, Sweden.
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 78Article in journal (Refereed) PublishedText
Abstract [en]

Background: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI).

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2016. Vol. 16, no 78
Keyword [en]
Acute myocardial infarction; Normal coronary arteries; Computed tomography coronary angiography; MINCA
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:liu:diva-129496DOI: 10.1186/s12872-016-0254-yISI: 000376723200001PubMedID: 27142217OAI: diva2:940206

Funding Agencies|Swedish Heart and Lung Foundation [20120449]; Region of Ostergotland [437491]; European Union FP 7 [223615]; Medical Research Council of Southeast Sweden [157921]

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2016-07-13

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Panayi, GeorgiosAlfredsson, JoakimKarlsson, Jan-ErikPersson, AndersEngvall, JanSwahn, Eva
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Department of Cardiology in LinköpingDepartment of Medical and Health SciencesFaculty of Medicine and Health SciencesDivision of Cardiovascular MedicineDivision of Radiological SciencesDepartment of Radiology in LinköpingCenter for Medical Image Science and Visualization (CMIV)Department of Clinical Physiology in Linköping
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