CONTEMPORARY APPROACHES TO MYOCARDIAL INFARCTION WITHOUT CORONARY ARTERY STENOSIS

Mamurjon Maxmudov; Xursand Tursunov; Barno Muhamedova; Maftuna Nazarova; Rasul Kuryozov

doi:10.56121/2181-3612-2025-6-162-171

№ 6 (2025): ноябрь-декабрь

162-171

2025-12-25

Открытый доступ

Макмудов Мамуржон Мансур оглы

Турсунов Хурсанд Мухсинович

Мухамедова Барно Фархадовна

Назарова Мафтуна Хамидуллаевна

Курёзов Расул Султонович

DOI: https://doi.org/10.56121/2181-3612-2025-6-162-171

Получена: 2025-12-25 12:30:45

Опубликована: 2025-12-25

Аннотация

Инфаркт миокарда без подъёма сегмента ST (NSTEMI) является одной из наиболее распространённых форм острого коронарного синдрома и относится к ведущим причинам смертности и инвалидизации, обусловленных сердечно-сосудистыми заболеваниями. В последние годы у определённой части пациентов с клинической картиной NSTEMI при проведении коронарной ангиографии не выявляются значимые стенозы, что соответствует понятию инфаркта миокарда без обструктивного поражения коронарных артерий (MINOCA). В представленном обзоре литературы освещены патогенетические механизмы, диагностические возможности, принципы оценки риска и персонализированного лечения инфаркта миокарда без обструктивного поражения коронарных артерий. Проведён анализ современных международных клинических рекомендаций, данных крупных регистров и систематических обзоров, посвящённых диагностике и лечению MINOCA. MINOCA представляет собой гетерогенный синдром, включающий различные патогенетические механизмы. Применение современных методов визуализации и этиологически ориентированного лечения способствует улучшению клинических исходов. Показано, что у пациентов с NSTEMI, протекающим в форме MINOCA, комплексная диагностика и механизмо-ориентированное персонализированное лечение являются оптимальной клинической стратегией.

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Список литературы

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264. doi:10.1161/CIR.0000000000000617.
Chapman AR, Adamson PD, Shah AS, Anand A, Strachan FE, Ferry AV, et al. High-sensitivity cardiac troponin and the universal definition of myocardial infarction. Circulation. 2020;141(3):161–171. doi:10.1161/CIRCULATIONAHA.119.042960. PMID:31587565.
Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, et al. Contemporary diagnosis and management of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): A scientific statement from the American Heart Association. Circulation. 2019;139(18):e891–e908.
Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF, et al. Systematic review of patients presenting with myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131(10):861–870.
Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjöld A, et al. Medical therapy for secondary prevention and long-term outcome in patients with MINOCA. J Am Coll Cardiol. 2017;69(11):1521–1532.
Scalone G, Niccoli G, Crea F, et al. Editor’s Choice—Pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care. 2019;8(1):54–62. doi:10.1177/2048872618782414. PMID:29952633.
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–1367.
Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826.
Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL, et al. Ischemia with no obstructive coronary artery disease (INOCA). Circulation. 2017;135(11):1075–1092.
Seitz A, Gardezy J, Pirozzolo G, Probst S, Athanasiadis A, et al. Long-term follow-up in patients with coronary artery spasm. JACC Cardiovasc Interv. 2020;13(16):1865–1876. doi:10.1016/j.jcin.2020.04.050.
Gerbaud E, Arabucki F, Nivet H, Barbou F, Dournes G, et al. OCT and CMR for the diagnosis of myocardial infarction with nonobstructive coronary arteries. JACC Cardiovasc Imaging. 2020;13(12):2619–2631.
Reynolds HR, Maehara A, Kwong RY, Sedlak T, Saw J, et al. Coronary optical coherence tomography and cardiac magnetic resonance imaging to determine underlying causes of MINOCA. JAMA. 2021;325(8):785–795.
Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, et al. Role of cardiac magnetic resonance in myocardial infarction with nonobstructive coronary arteries. Eur Heart J. 2021;42(18):1743–1754.
Mukhamedova BF, Salakhitdinov ShN, Nazarova MKh, Kazakov BO, et al. Improvement of specialized medical care of patients with acute coronary syndrome in Tashkent city. Challenges in Modern Medicine. 2022;45(2):152–165. doi:10.52575/2687-0940-2022-45-2-152-165.
Yuldoshev NP, Nagayeva GA, Zhuraliev MZh, Kholikulov SSh, Sanakulov ZhM, et al. Ticagrelor in the treatment of patients with acute coronary syndrome: own clinical experience. The Bulletin of Emergency Medicine (Shoshilinch tibbiyot axborotnomasi). 2022;15(6):23–31. doi:10.54185/TBEM/vol15_iss6/a5.
O‘zbekiston Respublikasi Sog‘liqni saqlash vazirligi. O‘tkir koronar sindrom va miokard infarkti bo‘yicha milliy klinik protokollar. Toshkent; 2024.
Niccoli G, Scalone G, Crea F, et al. Acute myocardial infarction with no obstructive coronary atherosclerosis. Eur Heart J. 2015;36(8):475–481.
Reynolds HR, Srichai MB, Iqbal SN, Slater JN, Mancini GBJ, et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124(13):1414–1425.
Gerbaud E, Arabucki F, Dournes G, et al. Plaque erosion detected by optical coherence tomography in MINOCA. JACC Cardiovasc Imaging. 2020;13(12):2622–2624.
Beltrame JF, Crea F, Kaski JC, Ogawa H, Shimokawa H, et al. International standardization of diagnostic criteria for vasospastic angina (COVADIS). Eur Heart J. 2017;38(35):2565–2568.
Ong P, Camici PG, Beltrame JF, Crea F, Shimokawa H, et al. International standardization of diagnostic criteria for microvascular angina. Int J Cardiol. 2018;250:16–20. doi:10.1016/j.ijcard.2017.08.068.
Taqueti VR, Di Carli MF. Coronary microvascular disease: pathogenic mechanisms and therapeutic options: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72(21):2625–2641. doi:10.1016/j.jacc.2018.09.042.
Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, et al. Spontaneous coronary artery dissection: current state of the science. Circulation. 2018;137:e523–e557.
Adlam D, Alfonso F, Maas A, Vrints C, et al. Management of spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353–3368.
Smilowitz NR, Mahajan AM, Roe MT, Hellkamp AS, Chiswell K, et al. Mortality of myocardial infarction with nonobstructive coronary arteries. J Am Heart Assoc. 2020;9:e014988.
Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, Holmes DR Jr. 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. PMID:29348012.
Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, et al. Prediction of risk of death and myocardial infarction in acute coronary syndromes: the GRACE risk score. BMJ. 2006;333:1091.
Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, et al. The TIMI risk score for unstable angina/non–ST elevation MI. JAMA. 2000;284:835–842.
Sandoval Y, Jaffe AS. Type 2 myocardial infarction: JACC review topic of the week. J Am Coll Cardiol. 2019;73(14):1846–1860. doi:10.1016/j.jacc.2019.02.018.
Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, et al. Cardiovascular magnetic resonance in myocardial infarction. J Am Coll Cardiol. 2018;72(24):3158–3176.
Dastidar AG, Baritussio A, De Garate E, De Caterina R, Bucciarelli-Ducci C, et al. Prognostic role of cardiac MRI in MINOCA. JACC Cardiovasc Imaging. 2019;12(10):1973–1982.
Pelliccia F, Pasceri V, Patti G, Tanzilli G, Speciale G, et al. Long-term prognosis and management of MINOCA. Eur Heart J. 2020;41(2):178–186.
Reynolds HR, et al. Multimodality imaging in myocardial infarction with nonobstructive coronary arteries. JAMA. 2021;325(8):765–767.
Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, et al. Antiplatelet therapy after acute coronary syndromes. Lancet. 2021;397(10287):1374–1387.
Taqueti VR, Dorbala S, Wolinsky D, Abbott B, Hachamovitch R, et al. Myocardial perfusion and outcomes in MINOCA. Circulation. 2021;144(10):735–748.
Smilowitz NR, Sedlis SP, et al. MINOCA: diagnostic and therapeutic challenges. Curr Cardiol Rep. 2022;24:197–206.
Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary embolism. Circulation. 2015;132(4):241–250.
Andersson HB, Pedersen F, Engstrøm T, Helqvist S, Jensen MK, Jørgensen E, et al. Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease. Eur Heart J. 2018;39(2):102–110. doi:10.1093/eurheartj/ehx491. PMID:29029035.
Nordenskjöld AM, Baron T, Eggers KM, Jernberg T, Lindahl B, et al. Predictors of adverse outcome in MINOCA. Int J Cardiol. 2018;261:18–23.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–3337. doi:10.1093/eurheartj/ehab484. PMID:34458905.
Kotseva K, De Backer G, De Bacquer D, Rydén L, Jennings C, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol. 2019;26(8):824–835. doi:10.1177/2047487318825350. PMID:30739508.
Pasupathy S, Tavella R, Beltrame JF. Myocardial infarction with nonobstructive coronary arteries (MINOCA): The past, present, and future management. Circulation. 2017;135(16):1490–1493. doi:10.1161/CIRCULATIONAHA.117.027666. PMID:28416521.
Reynolds HR, Jeroudi OM, Lima JAC, Srichai MB, et al. Myocardial infarction with nonobstructive coronary arteries. Annu Rev Med. 2023;74:201–216. doi:10.1146/annurev-med-042621-022322. PMID:36179347.
Lindahl B, Baron T, Albertucci M, Prati F. Myocardial infarction with non-obstructive coronary artery disease. EuroIntervention. 2021;17(11):e875–e887. doi:10.4244/EIJ-D-21-00426. PMID:34870600.
Pacheco C, Lee L, O’Donoghue ML, et al. Myocardial infarction with nonobstructive coronary arteries (MINOCA): Clinical practice update. Can J Cardiol. 2024;40:953–968. doi:10.1016/j.cjca.2024.02.032. PMID:38852985.