Aim: To describe the structural and functional condition of coronary blood flow in patients with MINOCA using MSCT, SPECT.
Material and methods. The study was registered on ClinicalTrials.gov: NCT03572023, as non-randomized, open, controlled. All patients underwent MSCT, SPECT, on the 6th day from the beginning of the index event. Primary endpoint: frequency of occurrence of atherosclerosis, frequency of occurrence of unstable plaques according to MSCT. Secondary endpoints: the magnitude of a transient defect in myocardial perfusion according to SPECT.
Results: The study included 14 patients with MINOCA (predominate women-78.6%). The average age was 61.1±14 years. The risk of GRACE was moderate in 8 (57%) pts. 12 (85.7%) pts were hospitalized within the first 6 hours of the onset of the disease, 2 (14.2%) pts had late admission (6-24h / =24h). Thrombolytic therapy was performed in 3 (21.4%) pts, it was effective in 14% of events. 57% of patients had a positive troponin test at admission. Intact coronary arteries were detected in 9 (64.3%) pts according to the results of ICA, 5 (35%) pts had stenosis up to 50%. Coronary slow flow (TIMI 2) was determined in 11 (78.6%) pts, 8 of them (57%) had coronary slow flow and intact coronary arteries. Coronary spasm was in 1 (7.1%) patient. According to MSCT the share of pts with intact coronary arteries decreased (9 (64.3%) ? 5 (35.7%)), however the share with non-obstructive atherosclerosis increased (5 (35%) ? 9 (64.3%)). All pts had a positive remodeling index, soft-tissue, predominantly calcified stenosis and eccentric plaques. 12 pts (85%) had transitory perfusion defects. The median SSS values were 7.5 (4; 13), SRS 4.7 (1.0; 9.0), SDS 4.7 (3.0; 8.0).
Conclusion. ?oronary slow flow and intact coronary arteries was revealed in 78% of pts with MINOCA according to ICA. MSCT showed only 36% of the pts without plaques, however it allows to identify eccentric soft tissue atherosclerotic plaques with a high risk of rupture/erosion. Using SPECT revealed a statistically significant transient perfusion defect.