040 Non ST-elevation myocardial infarction with a normal coronary angiogram in women: is it serious? - 07/07/11
Résumé |
Background |
The incidence and long term prognosis of women presenting troponin positive NSTE-ACS and a normal angiogram is unknown.
Aim |
To investigate the incidence, characteristics and long term prognosis of women presenting with a NSTEMI and normal coronary angiogram compared to women with NSTEMI and significant coronary artery disease (CAD) on the angiogram.
Methods |
Between 1999 and 2008, we screened patients presenting with an acute coronary syndrome (ACS) to identify those with a positive troponin and a normal angiogram. Extra-cardiac causes of troponin elevation were excluded. Women were matched by age and presence or absence of ST-elevation with a 1:2 ratio, to women with significant CAD. We compared characteristics and outcomes of the two groups of women.
Results |
Over 4085 ACS patients, 1581 had a significant elevation of troponin, with 343 women (21.7%) and 1238 men (78.3%). One hundred and twelve patients (7.1%) had a normal angiogram with a 3-fold higher proportion of women (14.5%; n = 50) compared to men (5.0%, n = 52); p<0.001.
When these women with a normal angiogram were compared with 100 women with significant CAD, they were less likely to have a high peak of troponin (> 5 times the upper limit of normal: 46% vs. 80%, p<0.0001). No other significant difference was found between the two groups. Mean follow-up was 4.3 +/− 3.1 years. Women with a normal angiogram had an excellent survival rate of 91.3% compared to 71.2% in women with CAD (p = 0.03), they had also a lower readmission rate for cardiovascular reason, (14% vs. 54%, p = 0.01).
Conclusion |
Women presenting with NSTEMI who have a normal angiogram, do not differ from women with NSTEMI and angiographic CAD. However, they have a smaller rise of troponin and a much better long-term prognosis.
Vol 3 - N° 1
P. 13 - janvier 2011 Retour au numéro
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