Baseline clinical characteristics and midterm prognosis of STE-ACS and NSTE-ACS patients with normal coronary arteries.
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.
Mazurkiewicz
Lukasz
L
Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland. l.mazurkiewicz@ikard.pl
Bilinska
Zofia T
ZT
Kruk
Mariusz
M
Ciszewski
Andrzej
A
Grzybowski
Jacek
J
Witkowski
Adam
A
Ruzyllo
Witold
W
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D019210:Troponin I