PhD defence Tobias Francis Sebastiaan Pustjens

Keywords: Acute coronary syndrome, Nonobstructive coronary artery disease, Multivessel disease, Coronary artery disease, 

"Challenges in Acute Coronary Syndromes: From nonobstructive to multivessel obstructive coronary arteries"

This thesis focused on improving the diagnosis and treatment of patients with acute heart attacks. 

Part I studied patients who showed signs of a heart attack without severely blocked coronary arteries, a condition called MINOCA. These patients had worse clinical outcomes, while the underlying cause of the presentation varied and could include different heart conditions. The research showed that additional testing is important to identify the correct diagnosis, and guide further treatment.

Part II studied patients with a heart attack and narrowing in several coronary arteries. It compared treating only the artery responsible for the heart attack with treating all important narrowings in other coronary arteries. The studies showed that treating all relevant coronary arteries during the initial procedure improved clinical outcomes. This was driven by a reduction of future procedures. 

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