Elsevier

American Heart Journal

Volume 152, Issue 4, October 2006, Pages 641-647
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
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

https://doi.org/10.1016/j.ahj.2006.02.035Get rights and content

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 38 301 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 38 301 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.

Section snippets

CRUSADE initiative

The CRUSADE quality improvement initiative is a nationwide program involving 465 hospitals in the United States. Data were collected on consecutive patients meeting the inclusion criteria only during the initial hospitalization in an anonymous fashion, and the institutional review board of each institution approved participation in this initiative. Data collected included baseline characteristics, use of short-term medications within 24 hours of presentation, use and timing of invasive cardiac

Prevalence and baseline characteristics

Of 88 097 patients included in the CRUSADE database from 2001 to 2003, 38 301 (43.4%) patients without a prior history of CABG were diagnosed with NSTEMI and underwent angiography. Of these 38 301 patients, 3306 patients (8.6%) were identified as having insignificant CAD, whereas 34 995 patients (91.4%) were found to have CAD. Patients without significant CAD were younger (median age 59 vs 64 years, P < .0001), more likely to be female (57% vs 35%, P < .0001), more often black (19% vs 10%, P <

Discussion

We undertook an analysis of the prevalence, predictors, and outcomes of patients with NSTEMI and insignificant CAD on angiography. Previous studies in patients with ACS and insignificant CAD were from clinical trial populations or consecutive angiography registries, but were not limited solely to patients with serum evidence of myocardial necrosis.5, 8, 9, 10 The CRUSADE initiative provides a large national sample of patients with high-risk NSTE ACS presenting to >400 US hospitals. From the

References (24)

Cited by (165)

  • Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA)

    2022, International Journal of Cardiology
    Citation Excerpt :

    Previously published data regarding the long-term prognosis of MINOCA are limited and conflicting [12]. MINOCA was initially broadly interpreted as describing an isolated event with a favorable prognosis, as corroborated by reports indicating a low short-term risk of recurrent MACE [7,12,13], but more recent data suggest there is a substantial risk of subsequent CV events [14–20], and this is supported by our findings. Almost one-third of the patients diagnosed as having MINOCA in our 20-year study of a large population of early-onset MI patients experienced at least one MACE.

  • Cardiac rehabilitation in women, challenges and opportunities

    2022, Progress in Cardiovascular Diseases
View all citing articles on Scopus

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.

View full text