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Not all myocardial infarctions are created equal: The potential of circulating microRNAs to discern coronary artery dissection.

EBioMedicine. 2021 May 6;67:103366. doi: 10.1016/j.ebiom.2021.103366. Epub ahead of print. PMID: 33965874.

Authors/Editors: Santovito D, Weber C.
Publication Date: 2021

Abstract

Acute myocardial infarction (AMI) is a dramatic manifestation of ischemic heart disease and represents a major cause of mortality worldwide, responsible for over 1 million hospitalizations annually in the United States. Notwithstanding, AMI encompasses different etiopathogenic mechanisms and, although atherothrombosis is the most common one, epidemiological evidence accumulates on the relevance of other causes, including spontaneous coronary artery dissection (SCAD). Described for the first time in the early 30 s, SCAD is obviously not a rare disease and may account for up to 4% of all AMIs and for 35% of those in young women (< 50 years old). It is characterized by the development of a hematoma in the media of the coronary artery with delamination of vessel wall and compression of the lumen, thus reducing coronary blood flow to prompt myocardial ischemia. In the light of the different pathogenesis, it is not unexpected that clinical management of acute SCAD and atherothrombotic AMI requires specific considerations as, for example, an invasive treatment strategy (i.e., percutaneous coronary intervention, PCI) results in higher complication rates and less predictable outcomes, whereas conservative management may be preferable in these patients. However, the clinical presentation of SCAD is the similar to atherothrombotic AMI, and diagnosis requires experienced interventional cardiologists and invasive approaches such as coronary angiography and optical coherence tomography. Hence, the discovery of easy-to-assess biomarkers for diagnosis of SCAD in patients with symptoms of AMI in emergency settings (e.g., emergency and chest-pain units) would improve their early identification and enable benefits with regards to therapeutic management. 

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