Non-Atherosclerosis Acute Coronary Syndrome: A Review Article
DOI:
https://doi.org/10.21776/ub/hsj.2024.005.03.3Keywords:
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
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).