Myocardial Infarction in Nine Patients with Radiologically Patent Coronary Arteries

Myocardial infarction with normal or near normal coronary arteries on cineangiography and without any other type of heart disease was found in nine (12 per cent) of a series of 78 consecutively studied patients. This combination occurred predominantly in young male patients, and its clinical, laboratory and electrocardiographic features, and its initial course were similar to those of acute myocardial infarction with coronary-artery disease. Multiple risk factors were present in only two patients. Hemodynamic findings were normal or near normal in seven. Areas of localized dyskinesia or hypokinesia were demonstrated in six on left ventricular cineangiography. The long-term clinical course has been benign; in no patient has congestive heart failure, major arrhythmias or recurrence of acute myocardial Infarction developed. It is possible that prolonged, localized coronary-artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism. (N Engl J Med 291:427–431, 1974)