Archive | 2019
ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ БЕЗ ОБСТРУКТИВНОГО ПОРАЖЕНИЯ КОРОНАРНЫХ АРТЕРИЙ: ТЯЖЕСТЬ КОРОНАРНОГО АТЕРОСКЛЕРОЗА И НАРУШЕНИЙ МИОКАРДИАЛЬНОЙ ПЕРФУЗИИ (ПИЛОТНОЕ ИССЛЕДОВАНИЕ)
Abstract
Aim . To study the structural and functional status of coronary blood flow in patients with acute coronary syndrome with nonobstructive\xa0coronary arteries using multispiral computed tomography (MSCT) and single photon emission tomography (SPECT)\xa0and to compare data of MSCT and invasive coronary angiography (ICA). Material and Methods . This study is a non-randomized, open-label, controlled clinical trial. The study is registered on\xa0ClinicalTrials.gov. The inclusion criteria are listed on the site. All patients underwent CT and SPECT. Results . The study included 14 patients with MINOCA; the group comprised predominantly women (n=11, 78.6%); the average\xa0age was 61.1±14 years. The risk according to GRACE (Global Registry of Acute Coronary Events) risk score was moderate in\xa08 patients (57%) and high in 5 patients (35.7%). 85.7% of patients were admitted to hospital within the first six hours from\xa0onset of diseases. Three patients (21.4%) received thrombolytic therapy and it was effective in two of them (14%). Risk factors\xa0included hypertension (64.2%), dyslipidemia (50%), and burdened history (71.4). According to the results of invasive coronary\xa0angiography, intact coronary arteries were detected in 9 patients (64.3%); 5 patients (35.7%) had stenosis up to 50%. Coronary\xa0slow-flow phenomenon (TIMI 2) was detected in 11 patients (78.6%) including 8 patients (57.1%) who had coronary slow-flow\xa0phenomenon and intact coronary arteries. Severe coronary spasm was registered in 1 patient (7.1%) in the group with ST\xa0segment elevation acute coronary syndrome (STE ACS). According to MSCT data, the proportion of patients with intact coronary\xa0arteries decreased from 7 (50%) to 5 patients (35.7%) whereas the proportion of patients with nonstenosing atherosclerosis\xa0increased from 7 (50%) to 9 patients (64.3%). Twenty six atherosclerotic plaques were detected including eccentric (76%),\xa0circular (11.5%), and semi-circular plaques (11.5%). In regard to morphological structure, the atherosclerotic plaques were\xa0calcified (59.5%), mostly calcified (7.7%), and soft (29%). Normal myocardial perfusion (Summed Stress Score (SSS) and Summed\xa0Rest Score (SRS) <4) was detected in two patients (14.3%); 12 patients (85%) had transitory perfusion defects. The median score\xa0values were 7.5 (4; 13) for SSS, 4.7 (1.0; 9.0) for SRS, and 4.7 (3.0; 8.0) for SDS. Conclusion. The introduction of MCTA and SPECT into the algorithm of the examination of patients with acute myocardial\xa0infarction and non-obstructive atherosclerosis of the coronary arteries was safe when additionally used during index\xa0hospitalization. These approaches provided new information about the structure and function of the coronary arteries. These\xa0data provide rationale for further study using a larger group of patients to determine a prognostic significance of detecting the\xa0atherosclerotic plaques with the signs of instability in this patient category.