MYOCARDIAL-INFARCTION WITH ANGIOGRAPHICALLY NORMAL CORONARY-ARTERIES

To determine the prevalence rate and clinical and hemodynamic profile of patients with myocardial infarction (MI) with angiographically norm al coronary arteries, we analyzed 3,403 consecutive angiograms perform ed within a 4.5-year period. Of these studies, 1,124 were performed fo llowing an acute MI. Through a computerized search, 12 patients were i dentified who had documented MI with normal or insignificant (<30% ste nosis in one epicardial vessel only) coronary disease. Q-wave MI devel oped in five patients (group A) and non-Q-wave MI developed in seven p atients (group B). Group B patients were all men whereas group B patie nts were all women. Overall, group A patients were younger (p=0.003), had a longer smoking history (p=0.008), and a higher cardiac index (p= 0.005). In ten patients, areas of localized dyskinesia or hypokinesia were shown on left ventricular cineangiography. Mitral valve prolapse was present in four of the patients and varying degrees of mitral regu rgitation were identified in another six. The prevalence rate of MI wi th angiographically normal coronary arteries was 1% in this study, Thi s entity had a bimodal age and sex distribution: a younger age group, all men, with a stronger cigarette smoking history who had Q-wave MI v s an older age group, all women, and no significant association with c igarette smoking who developed non-Q-wave MI. A mean follow-up of 4 ye ars demonstrated a favorable prognosis in both groups,