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- MI without obstructive CAD is common, occurring in 5–10% of patients w/woman most commonly affected
- Mechanisms for MI without obstructive CAD include vasospasm, embolism, myocarditis, dissection, tako-tsubo, and occult plaque rupture
- Recent studies have applied cardiac MRI (CMR) with intravascular ultrasound (IVUS) to determine the mechanism of MI without obstructive CAD
- In this study plaque disruption frequently occurred when the angiogram was normal or showed minimal atherosclerosis; Plaque rupture was demonstrated on IVUS in ~40% of women studied
- IVUS and CMR identified the potential mechanism of MI in 70%
- Consider theses adjunctive tools in the assessment of all patients with a clinical syndrome of MI who do not have obstructive CAD at angiography
References
Reynolds H. Myocardial infarction without obstructive coronary artery disease. Curr Opin Cardiol 2012, 27:655–660