Non-Atherosclerosis Acute Coronary Syndrome: A Review Article

Authors

DOI:

https://doi.org/10.21776/ub/hsj.2024.005.03.3

Keywords:

Coronary Artery Spasm, Coronary Syndrome, Non-Atherosclerosis Acute Myocardial Injury, Takotsubo Syndrome, Vasculitis.

Abstract

Non-atherosclerotic acute coronary syndrome (ACS) refers to a group of conditions that cause myocardial damage and clinical symptoms like traditional ACS but are not primarily caused by coronary artery plaque rupture or obstruction. This abstract provides an overview of the etiology, clinical presentation, diagnosis, and management of non-atherosclerotic ACS. Several etiologies can lead to non-atherosclerotic ACS, including coronary artery vasospasm, connective tissue disorders, stress-induced cardiomyopathy (Takotsubo syndrome), and vasculitis. The clinical presentation can mimic traditional ACS, with chest pain being the most common symptom. Diagnostic tools such as electrocardiography (ECG), laboratory biomarkers, echocardiography, coronary angiography, cardiac magnetic resonance imaging (MRI), and nuclear imaging play a crucial role in distinguishing non-atherosclerotic ACS from traditional ACS. Treatment strategies for non-atherosclerotic ACS are often based on expert consensus and clinical experience due to the lack of specific guidelines. Management approaches depend on the underlying etiology and may include pharmacological therapy, invasive interventions such as percutaneous coronary intervention (PCI) or surgery, and risk factor modification. Prompt diagnosis and appropriate management are crucial for improving patient outcomes. Further research and prospective studies are needed to enhance our understanding of non-atherosclerotic ACS and optimize its management.

References

Brothers JA, Frommelt MA, Jaquiss RDB, Myerburg RJ, Fraser CDJ, Tweddell JS. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2017;153(6):1440-1457. doi:10.1016/j.jtcvs.2016.06.066

Molossi S, Agrawal H, Mery CM, et al. Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach. Circ Cardiovasc Interv. 2020;13(2):e008445. doi:10.1161/CIRCINTERVENTIONS.119.008445

Nakashima T, Noguchi T, Haruta S, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol. 2016;207:341-348. doi:10.1016/j.ijcard.2016.01.188

Nishiguchi T, Tanaka A, Ozaki Y, et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Hear journal Acute Cardiovasc care. 2016;5(3):263-270. doi:10.1177/2048872613504310

Vrints CJM. Spontaneous coronary artery dissection. Heart. 2010;96(10):801-808. doi:10.1136/hrt.2008.162073

Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2014;84(7):1115-1122. doi:10.1002/ccd.25293

Hayes SN, Kim CESH, Saw J, et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement from the American Heart Association. Vol 137.; 2018. doi:10.1161/CIR.0000000000000564

Yumoto K, Sasaki H, Aoki H, Kato K. Successful treatment of spontaneous coronary artery dissection with cutting balloon angioplasty as evaluated with optical coherence tomography. JACC Cardiovasc Interv. 2014;7(7):817-819. doi:10.1016/j.jcin.2013.10.027

Alkhouli M, Cole M, Ling FS. Coronary Artery Fenestration Prior to Stenting in Spontaneous Coronary Artery Dissection. Vol 88. United States; 2016:E23-7. doi:10.1002/ccd.26161

Raphael CE, Heit JA, Reeder GS, et al. Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes. JACC Cardiovasc Interv. 2018;11(2):172-180. doi:10.1016/j.jcin.2017.08.057

Shibata T, Kawakami S, Noguchi T, et al. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism. Circulation. 2015;132(4):241-250. doi:10.1161/CIRCULATIONAHA.114.015134

Boekholdt SM, Kramer MHH. Arterial thrombosis and the role of thrombophilia. Semin Thromb Hemost. 2007;33(6):588-596. doi:10.1055/s-2007-985755

Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013). Circ J. 2014;78(11):2779-2801. doi:10.1253/circj.cj-66-0098

Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. J Cardiol. 2008;51(1):2-17. doi:10.1016/j.jjcc.2008.01.001

Sohn SM, Choi BG, Choi SY, et al. Impact of alcohol drinking on acetylcholine-induced coronary artery spasm in Korean populations. Atherosclerosis. 2018;268:163-169. doi:10.1016/j.atherosclerosis.2017.11.032

El Menyar AA. Drug-induced myocardial infarction secondary to coronary artery spasm in teenagers and young adults. J Postgrad Med. 2006;52(1):51-56.

Lanza GA, Careri G, Crea F. Mechanisms of coronary artery spasm. Circulation. 2011;124(16):1774-1782. doi:10.1161/CIRCULATIONAHA.111.037283

Beltrame JF, Crea F, Kaski JC, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2017;38(33):2565-2568. doi:10.1093/eurheartj/ehv351

Yasue H, Horio Y, Nakamura N, et al. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation. 1986;74(5):955-963. doi:10.1161/01.cir.74.5.955

Ishii M, Kaikita K, Sato K, et al. Acetylcholine-Provoked Coronary Spasm at Site of Significant Organic Stenosis Predicts Poor Prognosis in Patients With Coronary Vasospastic Angina. J Am Coll Cardiol. 2015;66(10):1105-1115. doi:10.1016/j.jacc.2015.06.1324

Park JY, Rha S-W, Poddar KL, et al. Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients. J Cardiol. 2012;60(3):187-191. doi:10.1016/j.jjcc.2012.02.007

Ciçek D, Kalay N, Müderrisoğlu H. Incidence, clinical characteristics, and 4-year follow-up of patients with isolated myocardial bridge: a retrospective, single-center, epidemiologic, coronary arteriographic follow-up study in southern Turkey. Cardiovasc Revasc Med. 2011;12(1):25-28. doi:10.1016/j.carrev.2010.01.006

Corban MT, Hung OY, Eshtehardi P, et al. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014;63(22):2346-2355. doi:10.1016/j.jacc.2014.01.049

Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49(5):587-593. doi:10.1016/j.jacc.2006.09.039

Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(22):2196-2212. doi:10.1016/j.jacc.2021.09.859

Cengel A, Tanindi A. Myocardial infarction in the young. J Postgrad Med. 2009;55(4):305-313. doi:10.4103/0022-3859.58944

Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408-417. doi:10.1016/j.ahj.2007.11.008

Naegele M, Flammer AJ, Enseleit F, et al. Endothelial function and sympathetic nervous system activity in patients with Takotsubo syndrome. Int J Cardiol. 2016;224:226-230. doi:10.1016/j.ijcard.2016.09.008

Frangieh AH, Obeid S, Ghadri J-R, et al. ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction. J Am Heart Assoc. 2016;5(6). doi:10.1161/JAHA.116.003418

Citro R, Bossone E, Parodi G, et al. Clinical profile and in-hospital outcome of Caucasian patients with takotsubo syndrome and right ventricular involvement. Int J Cardiol. 2016;219:455-461. doi:10.1016/j.ijcard.2016.06.039

Fröhlich GM, Schoch B, Schmid F, et al. Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy. Int J Cardiol. 2012;154(3):328-332. doi:10.1016/j.ijcard.2011.09.077

Warisawa T, Naganuma T, Nakamura S. Reversible Microvascular Dysfunction in Takotsubo Syndrome Shown Using Index of Microcirculatory Resistance. Circ J. 2016;80(3):750-752. doi:10.1253/circj.CJ-15-1283

Song BG, Yang HS, Hwang HK, et al. The impact of stressor patterns on clinical features in patients with tako-tsubo cardiomyopathy: experiences of two tertiary cardiovascular centers. Clin Cardiol. 2012;35(11):E6-13. doi:10.1002/clc.22053

Bietry R, Reyentovich A, Katz SD. Clinical management of takotsubo cardiomyopathy. Heart Fail Clin. 2013;9(2):177-186, viii. doi:10.1016/j.hfc.2012.12.003

Downloads

Published

2024-07-30