Adel Bakr
Cairo University Hospitals, Egypt
Title: Patients with non-obstructive coronary artery disease admitted with acute coronary syndrome carry a better outcome compared to those with obstructive coronary artery disease
Biography
Biography: Adel Bakr
Abstract
Purpose: The present study aimed to investigate the clinical profile, in-hospital and 3-months outcome of ACS patients with insignificant coronary stenosis on a coronary angiography. Methods: This prospective observational study included 200 consecutive patients admitted with ACS. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions ˃70% stenosis. Patients with previous CABG were excluded. Results: Patients with insignificant CAD were significantly younger (61 vs. 67 years, p<0.001), more likely to be females (41% vs. 23%, p=0.006), less likely to smoke (p=0.006), less likely to have diabetes mellitus (p<0.001), and less likely to have history of CAD (p=0.042) or prior PCI (p=0.037). At presentation these patients were also less likely to have typical anginal pain (61% vs 91%, p<0.001), less likely to have heart failure (9% vs 30%, p<0.001), less likely to have ischemic ST-segment changes (10% vs 46%, p<0.001), had lower elevations in peak troponin I (p<0.001) and CK-MB levels (p<0.001), with lower LDL-C (p=0.006), and higher HDL-C levels (p=0.020). They were less likely to be treated with thienopyridines (p<0.001), statins (p<0.001), b-blockers (p=0.002), ACEI/ARBS (p=0.007), and higher rates of calcium channel blocker therapy (p<0.001), this trend continued at discharge. They had lower prevalence of major adverse clinical events at follow up (readmission for ACS (p=0.009), revascularization (p=0.035), recurrent chest pain (p=0.009), cardiogenic shock (p=0.029). Conclusion: Patients with ACS and insignificant CAD have different clinical profile and outcome compared to those with significant disease.