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Brátt kransæðaheilkenni hjá sjúklingum með eðlilegar eða nær eðlilegar kransæðar

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Authors
Sævar Vignisson
Ingibjörg Guðmundsdóttir
Þórarinn Guðnason
Ragnar Daníelsen
Maríanna Garðarsdóttir
Karl Andersen
Issue Date
2018-05-03

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Other Titles
MINOCA in Iceland. Acute coronary syndrome in patients with normal or nonobstructive coronary arteries
Citation
Brátt kransæðaheilkenni hjá sjúklingum með eðlilegar eða nær eðlilegar kransæðar, 2018, 104(5):237-242 Læknablaðið
Abstract
Inngangur: Hin hefðbundna meingerð í bráðu kransæðaheilkenni hefur lengst af vera talin rof á æðakölkunarskellu sem leiðir til blóðsegamyndunar í kransæð og hjartavöðvadreps. Hjá hluta þessara sjúklinga er ekki um marktækt þrengdar kransæðar að ræða og aðrar orsakir en skellurof geta valdið þessum klínísku einkennum. Á undanförnum árum hefur verið vaxandi áhugi á að greina nánar undirliggjandi orsakir hjá þessum hópi sjúklinga. Nýverið var lýst sjúkdómsmyndinni MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) sem nær yfir þessa sjúklinga. Markmið rannsóknarinnar var að finna nýgengi MINOCA á Íslandi og að leita að undirliggjandi orsökum í íslensku þýði. Efni og aðferðir: Rannsóknin er afturskyggn gagnarannsókn úr gagnagrunni hjartaþræðingarstofu Landspítalans (SCAAR). Allir sjúklingar sem fengu vinnugreininguna STEMI / NSTEMI við komu á Landspítala á árunum 2012 til 2016 en reyndust hafa eðlilegar eða nær eðlilegar kransæðar (<50% þvermálsþrengsli) við kransæðamyndatöku voru rannsakaðir. Sjúkdómsgreiningar voru endurskoðaðar hjá öllum sjúklingum og flokkaðir samkvæmt flæðiriti sem sérstaklega var útbúið fyrir þessa rannsókn. Niðurstöður: Á rannsóknartímabilinu fóru 1708 sjúklingar í kransæðamyndatöku eftir að hafa fengið vinnugreininguna STEMI / NSTEMI. Af þeim reyndust 225 (13,2%) hafa eðlilegar eða nær eðlilegar kransæðar. Sjúkdómsgreiningar þessara sjúklinga skiptust þannig: fleiðurmyndun / rof á æðakölkunarskellu 72 (32%), hjartavöðvabólga 33 (14,7%), harmslegill 28 (12,4%), afleitt hjartavöðvadrep 30 (13,3%), kransæðakrampi 31 (13,8%) og 31 (13,8%) fengu greininguna annað og óútskýrt. Ályktun: Algengt er að sjúklingar með brátt kransæðaheilkenni hafi eðlilegar eða nær eðlilegar kransæðar við kransæðaþræðingu. Nokkuð jöfn skipting reyndist á milli helstu mismunagreininga. Með markvissri segulómskoðun á þessum sjúklingahópi mætti bæta mismunagreingu á undirliggandi orsökum.
Senda grein,Prenta greinEnglishFacebookTwitter Introduction: The classical pathophysiological process underlying acute coronary syndromes has been considered to be plaque rup­ture followed by platelet activation and aggregation and subsequent thrombus formation leading to myocardial ischemia and infarction. A substantial number of patients with acute coronary syndromes appear to have normal or near normal (<50% stenosis) coronary arteries on angiography. Recently, this clinical entity has been coined MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries). The purpose of this paper is to describe the proportion of MINOCA among ACS patients in Iceland. Material and methods: We performed a retrospective analysis of all admissions for acute coronary syndromes at Landspitali University Hospital, the single coronary catheterization facility in Iceland, during a five year period between 2012 and 2016. All patients admitted for STEMI or NSTEMI that turned out to have normal or near normal coronary arteries were consecutively included in the study. For each patient the diagnosis was re-evaluated according to further assessments using a diagnostic algorithm specially constructed for this study. Results: During the five year study period 1708 patients were studied with coronary angiography during first hospitalization for STEMI or NSTEMI. Among these, 225 (13.2%) had normal or non-obstructive coronary arteries with less than 50% luminal narrowing. The final diagnosis of these patients were plaque erosion / rupture in 72 indi­viduals (32%), myocarditis in 33 (14.7%), takotsubo cardiomyopathy in 28 (12.4%), type II myocardial infarction in 30 (13.3%), vasospastic angina in 31 (13.8%) and other or undetermined cause in 31 (13.8%) patients. Conclusion: The proportion of MINOCA in Iceland is 13.2% of patients admitted for acute coronary syndromes. Plaque erosion / rupture was considered a likely cause in one third of patients with other causes beeing evenly distributed with approximately half that frequency. Identification of the underlying cause of MINOCA would become more accurate with a consistent use of cardiac magnetic resonance imaging in these patients as it provided a definitive diagnosis in all of those ­studied.
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http://laeknabladid.is/tolublod/2018/05/nr/6722
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ae974a485f413a2113503eed53cd6c53
10.17992/lbl.2018.05.185
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Icelandic Journal Articles (Peer Reviewed)

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