Baseline clinical characteristics and midterm prognosis of STE-ACS and NSTE-ACS patients with normal coronary arteries.

Abstract

OBJECTIVE:

We sought to compare clinical profiles and midterm prognosis of patients with normal coronary arteries presenting with ST-elevation ACS (STE-ACS) versus non-ST-elevation ACS (nSTE-ACS).

BACKGROUND:

There are limited data regarding ACS in patients with normal coronary arteries, and especially clinical differences between ST-ACS and nSTE-ACS patients have not been evaluated sufficiently.

METHODS:

The study group comprised 190 patients (mean age: 53.2 years, 63.1% males, 63.6% STE-ACS) presenting with ACS and normal coronary angiograms. The participants were evaluated in terms of 42 clinical variables. MACE [cardiac death (CD) and hospitalization for angina (HA)] were the study end points.

RESULTS:

STE-ACS in comparison to nSTE-ACS patients were younger (P < 0.01), were more frequently males (P < 0.01), had more often infection prior to ACS (P < 0.01), higher hsCRP on admission (P < 0.01), and greater infarct size, measured by maximal troponin I (P < 0.01). By multivariate analysis in this subgroup, predictors of outcome were hsCRP (P = 0.03) and raised troponin I (P = 0.02). nSTE-ACS in comparison to STE-ACS patients were more obese (BMI, P < 0.01), had higher LDL cholesterol (P < 0.01), fasting glucose (P = 0.03). LDL cholesterol (P = 0.02) and fasting glucose (P = 0.03) emerged as independent predictors of outcome in these patients. Mean follow-up period was 25.4 months. STE-ACS patients had twice fewer MACE rate than nSTE-ACS patients [(1-CD, 12-HA; 11%) vs (1-CD, 16-HA; 25%), respectively, log rank P < 0.01].

CONCLUSIONS:

STE-ACS and nSTE-ACS patients with normal coronary arteriography have different clinical profiles. In nSTE-ACS patients more pronounced metabolic abnormalities were identified, while in STE-ACS patients inflammatory background was more significant.

• Authors: Lukasz Mazurkiewicz, Zofia T Bilinska, Mariusz Kruk, Andrzej Ciszewski, Jacek Grzybowski, Adam Witkowski, Witold Ruzyllo
• Journal: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc (Ann Noninvasive Electrocardiol) Vol. 14 Issue 1 Pg. 4-12 (Jan 2009) ISSN: 1542-474X [Electronic] United States
• PMID: 19149787 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• Troponin I

Topics

• Acute Coronary Syndrome (diagnosis, mortality, therapy)
• Adult
• Age Factors
• Aged
• Analysis of Variance
• Biomarkers (blood)
• Cause of Death
• Coronary Angiography
• Coronary Vessels (physiology)
• Electrocardiography
• Female
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Probability
• Proportional Hazards Models
• Prospective Studies
• Registries
• Severity of Illness Index
• Sex Factors
• Survival Analysis
• Troponin I (blood)