Статья
Инфаркт миокарда без обструкции коронарных артерий: современные подходы к диагностике и лечению
Инфаркт миокарда без обструкции коронарных артерий (ИМбОКА) диагностируется при коронарной ангиографии в случае отсутствия анатомически значимых стенозов (<50% cужения просвета) и характеризуется гетерогенностью этиологических факторов. В последнее время предприняты многочисленные попытки изучения механизмов ИМбОКА, а также исследования, направленные на совершенствование диагностических алгоритмов и терапевтических стратегий. Цель настоящего обзора состоит в том, чтобы отразить современные представления об этиологии и патогенезе ИМбОКА, методах обследования пациентов и дифференцированном подходе к лечению. В статье освещены актуальные эпидемиологические данные, особенности популяции пациентов с данным диагнозом, подробно рассмотрены его основные причины. Затронуты вопросы определения ИМбОКА, проблемы классификации других состояний, сопровождающихся повышением тропонина при отсутствии изменений в коронарных артериях. Подчеркивается важность индивидуализации лечебной тактики для отдельных пациентов, стратификации риска повторных сердечно-сосудистых событий. В обзоре приведены основные положения международных согласительных документов, опубликованных ведущими экспертами по проблеме, также обозначены перспективные направления дальнейших исследований.
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