Prevalence, predictors, and outcomes of patients with non–ST-segment elevation myocardial infarction and insignificant coronary artery disease: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative - 18/08/11
, Anita Y. Chen, MS a, Eric D. Peterson, MD, MPH a, L. Kristin Newby, MD, MHS a, Charles V. Pollack, MD, MA b, Ralph G. Brindis, MD, MPH c, C. Michael Gibson, MD d, Neal S. Kleiman, MD e, Jorge F. Saucedo, MD f, Deepak L. Bhatt, MD g, W. Brian Gibler, MD h, E. Magnus Ohman, MD a, Robert A. Harrington, MD a, Matthew T. Roe, MD, MHS aRésumé |
Background |
Unlike ST-segment elevation myocardial infarction, the degree of stenosis and physiology of ischemia varies in patients with non–ST-segment elevation myocardial infarction (NSTEMI). The prevalence, predictors, and outcomes of patients with NSTEMI who lack significant epicardial coronary artery disease (CAD) in routine clinical practice remain poorly characterized. We sought to determine the prevalence, predictors, and outcomes of patients with NSTEMI and insignificant CAD.
Methods |
We analyzed 38301 patients with NSTEMI in the CRUSADE quality improvement initiative who underwent cardiac catheterization to determine the prevalence and factors associated with insignificant CAD (all coronary stenoses <50%) and inhospital outcomes for patients with and without CAD. A multivariable model was used to determine the factors associated with insignificant CAD.
Results |
A total of 3306 (8.6%) of 38301 patients had insignificant CAD. The strongest multivariable predictors of insignificant CAD were female sex (odds ratio 2.8, 95% CI 2.6-3.1), younger age (odds ratio per 10-year decrease 1.5, 95% CI 1.5-1.6), and lack of current/recent smoking (odds ratio 1.9, 95% CI 1.7-2.0). Inhospital rates of death were 0.65% for patients with insignificant CAD compared with 2.36% for patients with CAD (P < .0001).
Conclusion |
Insignificant CAD is present in 9% of patients with NSTEMI and is associated with a low incidence of adverse outcomes. The strongest predictors of insignificant CAD are female sex and younger age. These findings underscore the need for research to understand the pathophysiology of myocardial infarction in this population.
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| CRUSADE is a national quality improvement initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb, New York, NY/Sanofi-Aventis Pharmaceuticals, Paris, France. Partnership provides additional funding support. Millennium Pharmaceuticals, Inc., Cambridge, MA, also funded this work. |
Vol 152 - N° 4
P. 641-647 - octobre 2006 Retour au numéro
Article précédent
- Implantable defibrillator early after primary percutaneous intervention for ST-elevation myocardial infarction: Rationale and design of the Defibrillator After Primary Angioplasty (DAPA) Trial
- Jan Paul Ottervanger, Anand R. Ramdat Misier, Felix Zijlstra, Martin J. Schalij, Eric Wever, Luc J.L.M. Jordaens, Jose P.S. Henriques, Menko-Jan de Boer, Hindrik W.J. Robbe, Hein J.J. Wellens, for the DAPA Investigators
- The impact of emergency department structure and care processes in delivering care for non–ST-segment elevation acute coronary syndromes
- Rajendra H. Mehta, L. Kristin Newby, Yogin Patel, James W. Hoekstra, Chadwick D. Miller, Anita Y. Chen, Barbara L. Lytle, Deborah B. Diercks, Richard L. Summers, Gerard X. Brogan, W. Frank Peacock, Charles V. Pollack, Matthew T. Roe, Eric D. Peterson, E. Magnus Ohman, W. Brian Gibler, for the CRUSADE Investigators
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