OBJECTIVES: 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.
OBJECTIVES: 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: Gaetano M De Ferrari; Keith A A Fox; Jennifer A White; Robert P Giugliano; Pierluigi Tricoci; Harmony R Reynolds; Judith S Hochman; C Michael Gibson; Pierre Théroux; Robert A Harrington; Frans Van de Werf; Harvey D White; Robert M Califf; L Kristin Newby Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-05-09
Authors: Joe X Xie; Parham Eshtehardi; Tina Varghese; Abhinav Goyal; Puja K Mehta; William Kang; Jonathon Leipsic; Bríain Ó Hartaigh; C Noel Bairey Merz; Daniel S Berman; Heidi Gransar; Matthew J Budoff; Stephan Achenbach; Tracy Q Callister; Hugo Marques; Ronen Rubinshtein; Mouaz H Al-Mallah; Daniele Andreini; Gianluca Pontone; Filippo Cademartiri; Erica Maffei; Kavitha Chinnaiyan; Gilbert Raff; Martin Hadamitzky; Joerg Hausleiter; Gudrun Feuchtner; Philipp A Kaufmann; Todd C Villines; Benjamin J W Chow; James K Min; Leslee J Shaw Journal: Circ Cardiovasc Imaging Date: 2017-08 Impact factor: 7.792
Authors: Sergio Leonardi; Claudio Montalto; Gianni Casella; Daniele Grosseto; Alessandra Repetto; Monica Portolan; Federico Fortuni; Filippo Ottani; Marcello Galvani; Laura Sofia Cardelli; Stefano De Servi; Andrea Rubboli; Gaetano Maria De Ferrari; Luigi Oltrona Visconti; Gianluca Campo Journal: Open Heart Date: 2020-12