Document Detail


Non-ST-elevation acute myocardial infarction with normal coronary arteries: predictors and prognosis.
MedLine Citation:
PMID:  19889337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION AND OBJECTIVES: Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute non-ST-elevation myocardial infarction (NSTEMI). The aim was to investigate predictive factors and prognosis in these patients. METHODS: The study involved 504 patients admitted for 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 a median of 3 years. In evaluating the secondary end-point, a control group of 160 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: Overall, 64 patients (13%) had coronary arteries without significant lesions. The predictors were: female sex (odds ratio [OR]=6.6; P=.0001), age <55 years (OR=3.0; P=.001), and the absence of diabetes (OR=2.4, P=.02), previous antiplatelet treatment (OR=3.9, P=.007) or ST-segment depression (OR=2.4, P=.008). The composite variable of female sex plus at least two additional predictive factors had a specificity of 85% and a sensitivity of 53% for coronary angiography showing no significant stenosis. The absence of coronary artery stenosis decreased the probability of death or myocardial infarction during follow-up (hazard ratio=0.3, 95% confidence interval, 0.2-0.9; P=.03). Among all patients without significant stenosis (n=224), 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 diabetes, previous antiplatelet treatment or ST-segment depression were all associated with coronary angiography showing no significant stenosis. The long-term prognosis in these patients was good.
Authors:
Alejandro Cortell; Juan Sanchis; Vicente Bod?; Julio N??ez; Luis Mainar; Mauricio Pellicer; Gema Mi?ana; Enrique Santas; Eloy Dom?nguez; Patricia Palau; Angel Ll?cer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Revista espa?ola de cardiolog?a     Volume:  62     ISSN:  1579-2242     ISO Abbreviation:  Rev Esp Cardiol     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2010-02-22     Revised Date:  2010-03-23    
Medline Journal Info:
Nlm Unique ID:  0404277     Medline TA:  Rev Esp Cardiol     Country:  Spain    
Other Details:
Languages:  eng     Pagination:  1260-6     Citation Subset:  IM    
Affiliation:
Servicio de Cardiolog?a, Hospital Cl?nico Universitario de Valencia, Valencia, Espa?a.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography*
Female
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  radiography*
Predictive Value of Tests
Prognosis
Comments/Corrections
Comment In:
Rev Esp Cardiol. 2010 Mar;63(3):371-2; author reply 372-3   [PMID:  20197005 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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