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{"title":"State of the Art in Imaging of Acute Coronary Syndrome with Nonobstructed Coronary Arteries.","authors":"César Urtasun-Iriarte, Ana Ezponda, Miguel Barrio-Piqueras, Gorka Bastarrika","doi":"10.1148/rg.240079","DOIUrl":null,"url":null,"abstract":"<p><p>Acute chest pain is a common concern for which patients present to the emergency department. Nonetheless, many patients with acute chest pain indicative of acute coronary syndrome (ACS) show nonobstructed coronary arteries at invasive coronary angiography or coronary CT angiography (CCTA), which is a clinical conundrum in day-to-day practice. Guidelines recommend that the initial course of action for patients experiencing acute chest pain is to exclude extracardiac and cardiac conditions that could cause nonischemic myocardial damage, including aortic dissection, pulmonary embolism, or septic shock. The generic term <i>troponin-positive with nonobstructed coronary arteries</i> (TpNOCA) was coined to refer to patients with nonobstructed coronary arteries who present with clinical symptoms and signs of ACS and increased cardiac troponin levels, electrocardiographic changes, or both. The causes of TpNOCA may be ischemic (eg, myocardial infarction with nonobstructed coronary arteries [MINOCA] or ischemia with nonobstructed coronary arteries [INOCA]) or nonischemic (eg, extracardiac and cardiac entities). MINOCA and INOCA are working diagnostic terms used until a definitive cause is established (eg, coronary plaque rupture, coronary artery dissection, or coronary microvascular disease). Noninvasive cardiac imaging techniques, notably CCTA and cardiac MRI, and ischemia testing are pivotal in evaluating and treating these patients through accurate identification of the underlying cause, improvement in risk stratification, and guidance for clinicians in decision making for treatment and follow-up. <sup>©</sup>RSNA, 2025.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":"45 5","pages":"e240079"},"PeriodicalIF":5.2000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiographics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1148/rg.240079","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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Abstract
Acute chest pain is a common concern for which patients present to the emergency department. Nonetheless, many patients with acute chest pain indicative of acute coronary syndrome (ACS) show nonobstructed coronary arteries at invasive coronary angiography or coronary CT angiography (CCTA), which is a clinical conundrum in day-to-day practice. Guidelines recommend that the initial course of action for patients experiencing acute chest pain is to exclude extracardiac and cardiac conditions that could cause nonischemic myocardial damage, including aortic dissection, pulmonary embolism, or septic shock. The generic term troponin-positive with nonobstructed coronary arteries (TpNOCA) was coined to refer to patients with nonobstructed coronary arteries who present with clinical symptoms and signs of ACS and increased cardiac troponin levels, electrocardiographic changes, or both. The causes of TpNOCA may be ischemic (eg, myocardial infarction with nonobstructed coronary arteries [MINOCA] or ischemia with nonobstructed coronary arteries [INOCA]) or nonischemic (eg, extracardiac and cardiac entities). MINOCA and INOCA are working diagnostic terms used until a definitive cause is established (eg, coronary plaque rupture, coronary artery dissection, or coronary microvascular disease). Noninvasive cardiac imaging techniques, notably CCTA and cardiac MRI, and ischemia testing are pivotal in evaluating and treating these patients through accurate identification of the underlying cause, improvement in risk stratification, and guidance for clinicians in decision making for treatment and follow-up. © RSNA, 2025.
无冠状动脉阻塞的急性冠状动脉综合征的影像学研究进展。
急性胸痛是急诊科就诊患者的常见病。然而,许多急性胸痛提示急性冠状动脉综合征(ACS)的患者在有创冠状动脉造影或冠状动脉 CT 血管造影(CCTA)中显示冠状动脉未阻塞,这是日常临床实践中的一个难题。指南建议,急性胸痛患者的初始治疗方案是排除可能导致非缺血性心肌损伤的心外和心脏疾病,包括主动脉夹层、肺栓塞或脓毒性休克。肌钙蛋白阳性且冠状动脉未阻塞(TpNOCA)这一通用术语是指冠状动脉未阻塞的患者,这些患者具有 ACS 的临床症状和体征,但心肌肌钙蛋白水平、心电图变化或两者均增高。TpNOCA 的病因可能是缺血性的(如冠状动脉未阻塞的心肌梗死 [MINOCA] 或冠状动脉未阻塞的心肌缺血 [INOCA]),也可能是非缺血性的(如心外和心脏实体)。MINOCA 和 INOCA 是在确定病因(如冠状动脉斑块破裂、冠状动脉夹层或冠状动脉微血管疾病)之前使用的工作诊断术语。无创心脏成像技术,尤其是 CCTA 和心脏核磁共振成像,以及缺血测试对评估和治疗这些患者至关重要,可准确识别潜在病因,改善风险分层,并为临床医生的治疗和随访决策提供指导。©RSNA, 2025.
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