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Structural and functional condition of coronary blood flow in patients with acute coronary syndromes and non-obstructive coronary artery disease.

Session Moderated Poster 7: Acute Coronary Syndromes II

Speaker Darya Vorobyeva

Event : Acute Cardiovascular Care 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Myocardial Infarction with Non-obstructive Coronary Arteries
  • Session type : Moderated Posters

Authors : DA Vorobyeva (Tomsk,RU), KV Zavadovsky (Tomsk,RU), AV Mochula (Tomsk,RU), OV Mochula (Tomsk,RU), SB Fedorova (Tomsk,RU), WYU Ussov (Tomsk,RU), VA Markov (Tomsk,RU), SV Demyanov (Tomsk,RU), AG Syrkina (Tomsk,RU), VV Ryabov (Tomsk,RU)

DA Vorobyeva1 , KV Zavadovsky1 , AV Mochula1 , OV Mochula1 , SB Fedorova1 , WYU Ussov1 , VA Markov1 , SV Demyanov1 , AG Syrkina1 , VV Ryabov1 , 1Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences - Tomsk - Russian Federation ,


Background: Approximately 1–14% of patients with acute coronary syndrome (ACS) did not have obstructive changes in the coronary arteries according to the data of invasive coronary angiography (ICA). In the absence of other cause to increase of myocardial necrosis markers associated with myocardial infarction (AMI) with non-obstructive coronary artery - MINOCA. Multispiral computed tomography (MSCT) has the ability to assess the lumen of the vessel, visualize the artery wall, the structure of the atherosclerotic plaque. The method of single-photon emission computed tomography (SPECT) is used for detect myocardial ischemia, also it could be useful for the assessment of functional significance of atherosclerotic plaques and regional tissue perfusion. There are no data about a research of a structurally functional condition of a coronary blood-groove by using of MSCT, SPECT.

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 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.

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