Key Points for Interventional Cardiologists during a Coronariography of a Patient with Myocardial Infarction with Non-Obstructive Coronary Arteries

Acute myocardial infarction with non-obstructive coronary disease (MINOCA) groups entities with various pathophysiological mechanisms. Some of them are related to vascular alterations in different levels. We aim to analyze the technical difficulties presented in the vascular accesses in the hemodynamic laboratory, as well as the main findings of coronary angiography.

An analytical, observational and prospective study in a hospital covering a population of 215,000. The definitions of the ESC working group position paper on MINOCA of 2016 were used. We collected demographic, clinical and angiographic data from 86 patients diagnosed of MINOCA, during 26 months. As a control group, 122 consecutive patients with obstructive coronary disease were included. Death, adverse cardiovascular events, reentry, and functional class worse than II were analyzed.

Adjusted for sex and presence of cardiovascular risk factors, there were more difficulties to catheterize the radial artery in patients with MINOCA (22.5 vs 9.4%, p <0.01). We observed tortuosity in the arteries of the arm that impeded or hindered the progression of the material in 8.4% of MINOCA patients.

We observed a higher proportion of ectasia in patients with MINOCA (6.9 vs 0.84, p 0.02), as well as myocardial bridging with milking effect (10.5 vs 1.7%, p <0.01). During follow-up (mean 12.5 months), neither difficulties with vascular access, nor milking or ectasia had an impact on prognosis.

Patients with MINOCA present more complications in radial access. This may be due to the fact that the pathophysiological substrate of MINOCA also affects peripheral arteries, making access difficult. Further studies are needed to confirm this.