title: Risk Factors and Markers for Acute Myocardial Infarction With Angiographically Normal Coronary Arteries.
abstract: Myocardial Infarction with normal coronary arteries (MINCA) is common with a prevalence of 1% to 12% of all myocardial infarctions. The pathogenic mechanisms of MINCA are still unknown, but endothelial dysfunction has been suggested as a possible cause. To investigate risk factors and markers for MINCA, we conducted a case-control study. Considering the reported low prevalence of classical risk factors for coronary heart disease (CHD) in some but not all studies, our hypothesis was that endothelial function and intima-media thickness (IMT) were better, respectively lower, than CHD controls. One hundred patients with MINCA fulfilling diagnostic criteria according to the European Society of Cardiology/American Collage of Cardiology/American Heart Association universal definition of myocardial infarction with myocarditis excluded by cardiac magnetic resonance imaging were investigated. Risk factors, endothelial function (EndoPAT), and IMT were compared to gender- and age-matched patients with myocardial infarction and CHD, respectively healthy controls. Smoking, hypertension, impaired glucose tolerance and diabetes mellitus, inflammatory disease, and psychiatric disorders were more common in patients with MINCA than in healthy controls. In contrast to patients with CHD, the lipid profile was antiatherogenic with low low-density lipoprotein and high high-density lipoprotein cholesterol. There were no major differences between the groups regarding endothelial function and IMT that were in the normal range. In conclusion, the present study showed that MINCA was associated with many established cardiovascular risk factors without major differences in atherosclerosis markers. MINCA patients recalled a high prevalence of emotional stress before admission that together with previous psychiatric vulnerability and female gender speaks strongly in favor of Takotsubo syndrome being an important cause of MINCA.
authors.affiliation: Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Medicine Clinic, Department of Cardiology, Capio S:t Göran Hospital, Stockholm, Sweden. Electronic address: maria.daniel@ki.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Daniel
authors.affiliation: Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Ekenbäck
authors.affiliation: Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Institute of Clinical Medicine, Department of Cardiology, University of Oslo, Oslo, Norway.
authors.forename: Stefan
authors.initials: S
authors.lastname: Agewall
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elin B
authors.initials: EB
authors.lastname: Brolin
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Cederlund
authors.affiliation: Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olov
authors.initials: O
authors.lastname: Collste
authors.affiliation: Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Eurenius
authors.affiliation: Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Frick
authors.affiliation: Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Shams
authors.initials: S
authors.lastname: Younis-Hassan
authors.affiliation: Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Loghman
authors.initials: L
authors.lastname: Henareh
authors.affiliation: Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Malmqvist
authors.affiliation: Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Spaak
authors.affiliation: Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peder
authors.initials: P
authors.lastname: Sörensson
authors.affiliation: Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Hofman-Bang
authors.affiliation: Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007249:Inflammation; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D010991:Plethysmography; D012307:Risk Factors; D012737:Sex Factors; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D014280:Triglycerides / Q000097:blood; D014664:Vasodilation / Q000502:physiology
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D002097:C-Reactive Protein