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2023, Número 3

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Cardiovasc Metab Sci 2023; 34 (3)


Infarto de miocardio con arterias coronarias no obstructivas e isquemia de arterias coronarias no obstructivas, recomendaciones de COMECITE

Olvera-Ruiz R, Moguel-Ancheita R, Facundo-Bazaldua S, Lozoya-Morales JJ, Ramos-Cházaro E, Arce-Piña LA, Muñoz-Beltrán LG, Buenfil-Medina JC, Victoria-Nandayapa JR, Bautista-López GR, Olivares-Asencio CA

Idioma: Inglés [English version]
Referencias bibliográficas: 92
Paginas: 127-141
Archivo PDF: 299.03 Kb.


RESUMEN

El infarto y la isquemia del miocardio sin lesiones coronarias obstructivas (MINOCA, INOCA, por sus siglas en inglés) son conceptos controvertidos. Una lesión no obstructiva ≤ 50% implica la presencia de aterosclerosis que puede complicarse con ruptura o erosión de placa y trombosis presentes en los síndromes coronarios agudos, los cuales son tiempo dependientes y no fácilmente detectables por imagen intravascular. El mayor registro de MINOCA es el sueco, que reportó 9,092 pacientes utilizando angiografía coronaria únicamente, sin imagen intravascular, lo que deja poco claro si hubo disección, erosión o ruptura de placa; así como tampoco especifica la presencia de enfermedad de Takotsubo, miocarditis o cardiomiopatía. El diagnóstico de MINOCA debe tener elevación de marcadores o enzimas cardiacas, con o sin cambios electrocardiográficos y anomalías en la movilidad segmentaria, angiografía coronaria e imagen intravascular. INOCA debe tener un estudio inductor de isquemia positivo, angiografía coronaria, estudio fisiológico coronario hiperémico con la determinación del flujo de reserva fraccional (FFR, por sus siglas en inglés) y el flujo de reserva coronaria (CFR, por sus siglas en inglés) para el diagnóstico de certeza.


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