title: Coronary plaque burden, as determined by cardiac computed tomography, in patients with myocardial infarction and angiographically normal coronary arteries compared to healthy volunteers: a prospective multicenter observational study.
abstract: OBJECTIVE
  Patients presenting with acute myocardial infarction and angiographically normal coronary arteries (MINCA) represent a diagnostic and a therapeutic challenge. Cardiac computed tomography (CT) allows detection of coronary artery disease (CAD) even in the absence of significant stenosis. We aimed to investigate whether patients suffering from MINCA had a greater coronary plaque burden, as determined by cardiac CT, than a matched group of healthy volunteers.
  
  
  METHODS
  Consecutive patients, aged 45 to 70, with MINCA were enrolled in the Stockholm metropolitan area. Patients with myocarditis were excluded using cardiovascular magnetic resonance imaging. Remaining patients underwent cardiac CT, as did a reference group of healthy volunteers matched by age and gender, with no known cardiovascular disease. Plaque burden was evaluated semi-quantitatively on a per patient and a per segment level.
  
  
  RESULTS
  Despite a higher prevalence of smoking and hypertension, patients with MINCA did not have more CAD than healthy volunteers. Among 57 MINCA patients and 58 volunteers no signs of CAD were found in 24 (42%) and 25 (43%) respectively. On a per segment level, MINCA patients had less segments with stenosis ≥ 20% (2% vs. 5%, p<0.01), as well as a smaller proportion of large (2% vs. 4%, p<0.05) and mixed type plaques (1% vs. 4%, p<0.01). The median coronary calcium score did not differ between MINCA patients and healthy volunteers (6 vs. 8, ns).
  
  
  CONCLUSIONS
  MINCA patients with no or minimal angiographic stenosis do not have more coronary atherosclerosis than healthy volunteers, and a large proportion of these patients do not have any signs of CAD, as determined by cardiac CT. The MINCA patient group is probably heterogeneous, with a variety of different underlying mechanisms. Non-obstructive CAD is most likely not the most prevalent cause of myocardial infarction in this patient group.
authors.affiliation: Department of Radiology, Karolinska University Hospital Huddinge and Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elin B
authors.initials: EB
authors.lastname: Brolin
authors.affiliation: Department of Medicine, Section of Cardiology, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Department of Radiology, Karolinska University Hospital Huddinge and Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden.
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Daniel
authors.affiliation: Department of Medicine, Section of Cardiology, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Loghman
authors.initials: L
authors.lastname: Henareh
authors.affiliation: Department of Radiology, Karolinska University Hospital Huddinge and Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonaz
authors.initials: J
authors.lastname: Ripsweden
authors.affiliation: Institution for Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
authors.affiliation: Department of Radiology, Karolinska University Hospital Huddinge and Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Cederlund
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed