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Incidence of myocardial infarction with nonobstructive coronary arteries in patients with acute coronary syndrome

Objective To estimate the incidence of myocardial infarction with nonobstructive coronary arteries (MINOCA) among Egyptian cases with acute myocardial infarction (AMI) and to evaluate the role of neutrophilic elastase in AMI cases. Background Previous research studies have declared that MINOCA is a syndrome with angiographic normal or near-normal coronary arteries but had evidence of MI clinically, which has many causes. Patients and methods To reach the goal of this research, a group study was designed. A total of 627 cases admitted at Cardiology Department of Faculty of Medicine Menoufia University and National Heart Institute in the period from February 2019 to July 2019 were included. Cases were divided into two groups: group 1 included AMI cases with obstructive coronary artery disease group, and group 2 included AMI cases with nonobstructive coronary artery disease (MINOCA group). All cases were subjected to (a) full history taking; (b) clinical examination; (c) laboratory investigations, such as serum HbA1C, cardiac enzymes (total creatine kinase, creatine kinase-myocardial band, and troponin), and serum neutrophil elastase; and (d) other investigations, including ECG and coronary angioplasty. Results There were 627 acute coronary syndrome cases, and 49 cases were diagnosed as MINOCA. Regarding the risk factors, diabetes mellitus and smoking showed a significant difference in-between both studied groups (P = 0.038 and 0.014, respectively). Conclusion Our study concluded that ~7.8% of the Egyptian cases that presented with AMI for primary percutaneous coronary intervention have MINOCA. High serum neutrophilic elastase concentration is a sensitive marker, suggesting the existence of complex atheromatous plaques in AMI cases.