Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries

Study objectives: Myocardial infarction with angiographically normal corona ry arteries (MINC) is a life-threatening event with man open questions for physicians and patients, There are little data concerning the prognosis for patients with MINC, Design: Retrospective follow-up study, Setting: Tertiary referral center. Patients: Patients with MINC were investigated and compared to age- and sex -matched control subjects with myocardial infarction due to coronary artery disease (CAD). The patients were examined clinically using stress exercise and hyperventilation tests, Migraine and Raynaud's symptoms were determine d by means of a standardized questionnaire. Serum lipoproteins; the seropre valence of cytomegalovirus, Helicobacter pylori, and Chlamydia pneumoniae i nfections; and the most frequent causes of thrombophilia were assessed. Measurements and results: From > 4,300 angiographies that were pet-formed b etween 1989 and 1996, 21 patients with MINC were identified, The mean +/- S D patient age at the time of myocardial infarction was 42 +/- 7.5 years. Wh en compared to control subjects (n 21), patients with MINC had fewer risk f actors for CAD. In contrast, MINC patients had more frequent febrile reacti ons prior to myocardial infarction (six patients vs zero patients; p < 0.05 ), and the migraine score was significantly higher (7.1 +/- 6.3 vs 2.2 +/- 4.1; p < 0.01), The seroprevalence of antibodies against cytomegalovirus, C pneumoniae, and H pylori tended to be higher in patients with MINC and CAD as compared to matched healthy control subjects. Three patients with MINC cs none with CAD had coagulopathy, During follow-up (53 +/- 37 months), no major cardiac event occurred in the MINC group; no patients with MINC vs ni ne with CAD (p = 0.0001) underwent repeated angiography. Conclusion: High migraine score and prior febrile infection together with a lower cardiovascular risk profile are compatible with an inflammatory and a vasomotor component in the pathophysiology of the acute coronary event in MINC patients. The prognosis for these patients is excellent.