Prevalence, predictors, and prognosis of patients with non ST-segment elevation myocardial infarction and insignificant coronary artery disease

الملخص EN

Objective : The aim of present study was to investigate the prevalence, predictors and prognosis in patients with non ST-elevation myocardial infarction (NSTEMI) without significant coronary artery stenosis.

In addition, follow-up was conducted and the factors related to prognosis were analyzed.

Finally, the disease course was compared with that of a control group of patients who were admitted for chest pain of possible coronary origin and who had normal troponin levels and normal coronary arteries.

Methods : The study involved 302 patients admitted for acute NSTEMI who underwent cardiac catheterization.

The primary end-point was the observation of coronary arteries without significant stenosis, and the secondary end-point was death or myocardial infarction within 6 months.

In evaluating the secondary end-point group of 88 patients with a normal troponin level and no significant coronary artery stenosis who were admitted for chest pain during the same period was included.

Results : Thirty three patients (10.9 %) had coronary arteries without significant lesions.

The predictors were : female sex (odds ratio [OR] = 3, p = 0.006), age <55 years (OR = 2.8, p = 0.01), and the absence of ST segment depression (OR = 2.6, p = 0.04).

The absence of significant coronary artery stenosis decreased the probability of death or myocardial infarction during follow-up (hazard ratio = 0.4, 95 % confidence interval: 0.3-0.9 ; p = 0.02).

Among all patients without significant stenosis (n = 121), there was no difference in the event rate between those with elevated and normal troponin levels.

Conclusions : In NSTEMI, female sex, age<55 years and the absence of ST-segment depression were all associated with coronary angiography showing no significant stenosis.

The prognosis in these patients was good.