Sally Aldous1, John Elliott2, Dougal McClean2, Aniket Puri2, A Mark Richards3. 1. Cardiology Department, Christchurch Hospital, Christchurch, New Zealand. Electronic address: sally.aldous@cdhb.health.nz. 2. Cardiology Department, Christchurch Hospital, Christchurch, New Zealand. 3. National University Heart Centre, Singapore; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Abstract
BACKGROUND: Many patients provisionally diagnosed with acute myocardial infarction (AMI) have angiographically unobstructed coronary arteries. Despite other potential causes, patients are often diagnosed as AMI with psychosocial implications and medication burden. The aim of this audit was to review such patients at our centre. METHODS: All patients investigated for possible AMI with coronary angiography from 2007 until 2011 at Christchurch Hospital, New Zealand, in whom cardiac troponin was elevated (with no other cause found for that elevation) but coronary angiography showed diameter stenosis <50% were reviewed. Primary outcome was two-year cardiac death and AMI (by universal definition). RESULTS: Of the 351/6493 (5.4%) who met the inclusion criteria, 180 had normal angiograms and 171 had non-obstructive coronary disease (stenosis >0% and <50%). By two years there were two cardiac deaths (0.6%) and five AMIs (1.4%). The primary outcome rate was therefore 2.0% (2.2% for those with normal angiograms and 1.8% with non-flow limiting coronary disease, p=1.000). CONCLUSION: Patients who have presented with AMI symptoms, elevated cardiac troponin, and unobstructed coronary arteries on angiography are at very low risk of cardiac death (0.6%), AMI (1.4%) or either (2.0%) at two-year follow-up.
BACKGROUND: Many patients provisionally diagnosed with acute myocardial infarction (AMI) have angiographically unobstructed coronary arteries. Despite other potential causes, patients are often diagnosed as AMI with psychosocial implications and medication burden. The aim of this audit was to review such patients at our centre. METHODS: All patients investigated for possible AMI with coronary angiography from 2007 until 2011 at Christchurch Hospital, New Zealand, in whom cardiac troponin was elevated (with no other cause found for that elevation) but coronary angiography showed diameter stenosis <50% were reviewed. Primary outcome was two-year cardiac death and AMI (by universal definition). RESULTS: Of the 351/6493 (5.4%) who met the inclusion criteria, 180 had normal angiograms and 171 had non-obstructive coronary disease (stenosis >0% and <50%). By two years there were two cardiac deaths (0.6%) and five AMIs (1.4%). The primary outcome rate was therefore 2.0% (2.2% for those with normal angiograms and 1.8% with non-flow limiting coronary disease, p=1.000). CONCLUSION:Patients who have presented with AMI symptoms, elevated cardiac troponin, and unobstructed coronary arteries on angiography are at very low risk of cardiac death (0.6%), AMI (1.4%) or either (2.0%) at two-year follow-up.
Authors: Rachel P Dreyer; Rosanna Tavella; Jeptha P Curtis; Yongfei Wang; Sivabaskari Pauspathy; John Messenger; John S Rumsfeld; Thomas M Maddox; Harlan M Krumholz; John A Spertus; John F Beltrame Journal: Eur Heart J Date: 2020-02-14 Impact factor: 35.855
Authors: Oskar Wojciech Wiśniewski; Franciszek Dydowicz; Szymon Salamaga; Przemysław Skulik; Jacek Migaj; Marta Kałużna-Oleksy Journal: J Pers Med Date: 2022-06-27