Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients

Gaetano M. De Ferrari, Keith A A Fox, Jennifer A. White, Robert P. Giugliano, Pierluigi Tricoci, Harmony R. Reynolds, Judith S. Hochman, C. Michael Gibson, Pierre Théroux, Robert A. Harrington, Frans Van de Werf, Harvey D. White, Robert M. Califf, L. Kristin Newby

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS: Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.

METHODS AND RESULTS: We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (OR(adj) 0.15; 95% CI, 0.11-0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (OR(adj) 0.19 (0.14-0.25) and 0.37 (0.28-0.49), respectively).

CONCLUSION: Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group.

Original languageEnglish
Pages (from-to)37-45
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume3
Issue number1
DOIs
Publication statusPublished - Mar 1 2014

Keywords

  • Acute coronary syndromes
  • angiography
  • atherosclerosis
  • coronary disease
  • infarction

ASJC Scopus subject areas

  • Medicine(all)

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