title: Patients with acute coronary syndrome and nonobstructive coronary artery disease in the real world are markedly undertreated.
abstract: OBJECTIVE
  We assessed the clinical profile of patients with acute coronary syndrome (ACS) and nonobstructive coronary artery disease (CAD) in a real world setting, focusing on pattern of care and on prognosis.
  
  
  METHODS
  Each nonobstructive CAD (<50% stenosis in any epicardial coronary artery) patient was matched with an obstructive CAD patient; adjusted estimates of prescription of guideline-recommended drugs at discharge and of long-term prognosis were evaluated.
  
  
  RESULTS
  Among 2995 consecutive ACS patients who underwent coronary angiography, 125 (4.2%) had nonobstructive CAD. Nonobstructive CAD patients had significantly lower odds of receiving aspirin [odds ratio (OR) 0.31, 95% confidence interval (CI): 0.14-0.68], thienopyridines (OR 0.01, 95% CI: 0.00-0.07), statins (OR 0.31, 95% CI: 0.17-0.58), beta-blockers (OR 0.32, 95% CI: 0.17-0.63) and angiotensin converting enzyme-inhibitors /angiotensin receptor blockers (OR 0.36, 95% CI: 0.17-0.91) compared with matched patients. During a 3-year follow-up, nonobstructive CAD patients had significantly fewer cardiovascular deaths and myocardial infarctions but numerically more episodes of unstable angina.
  
  
  CONCLUSIONS
  The prevalence of nonobstructive CAD appears lower (4.2%) compared with published data. After extensive adjustment, patients with nonobstructive CAD were significantly less likely to be treated with guideline-recommended therapy, including aspirin and statins. Multicenter prospective studies targeting this specific population and the potential benefit of guideline-recommended therapies appear warranted.
authors: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. g.deferrari@smatteo.pv.it
authors: Gaetano M
authors: GM
authors: De Ferrari
authors: Sergio
authors: S
authors: Leonardi
authors: Lara
authors: L
authors: Baduena
authors: Enrico
authors: E
authors: Chieffo
authors: Angela
authors: A
authors: Lesce
authors: Alessandra
authors: A
authors: Repetto
authors: Mario
authors: M
authors: Previtali
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents