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
