Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients
Aims: Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compar...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2014-03, Vol.3 (1), p.37-45 |
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| creator | De Ferrari, Gaetano M Fox, Keith AA White, Jennifer A Giugliano, Robert P Tricoci, Pierluigi Reynolds, Harmony R Hochman, Judith S Gibson, C Michael Théroux, Pierre Harrington, Robert A Van de Werf, Frans White, Harvey D Califf, Robert M Newby, L Kristin |
| description | Aims:
Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.
Methods and results:
We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (ORadj 0.15; 95% CI, 0.11–0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (ORadj 0.19 (0.14–0.25) and 0.37 (0.28–0.49), respectively).
Conclusion:
Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group. |
| doi_str_mv | 10.1177/2048872613489315 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3932771</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2048872613489315</sage_id><sourcerecordid>1501834242</sourcerecordid><originalsourceid>FETCH-LOGICAL-c434t-a22e4168713445411db3792de19dfe7bd1970f67e407ce9426f4b29f4447e4dc3</originalsourceid><addsrcrecordid>eNp1UUtv1DAQthCIVkvvnJCPHAj4MRsnHJBQRQGpUg-Us-U4k6yrxF5sZ9H-JP4l3m5ZFSR8GWvme4zmI-QlZ285V-qdYNA0StRcQtNKvn5Czg-tqlESnp7-oj4jFyndsfIUq6GRz8mZgHUtGibOya-bJdswY6JmDn6kPvjq222VcJzRZ4oT7kx2wVNjl4zUhhi8iXua9r6P97xtmRdooj9d3hQ-NX50YYxmu3HWTNOehi7luNjsdo8ETMxYSu8SmoTvDyCMR69EhyJNpXrDGT_pvyDPBjMlvHioK_L96tPt5Zfq-ubz18uP15UFCbkyQiDwulHlLLAGzvtOqlb0yNt-QNX1vFVsqBUCUxZbEPUAnWgHACi93soV-XDU3S7djL0t3tFMehvdXPbWwTj998S7jR7DTstWClVsV-T1g0AMPxZMWc8uWZwm4zEsSfM1440EAaJA2RFqY0gp4nCy4UwfQtb_hlworx6vdyL8ibQAqiMgmRH1XViiL-f6v-BvdOyzsg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1501834242</pqid></control><display><type>article</type><title>Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients</title><source>MEDLINE</source><source>Oxford University Press Journals Current</source><source>EZB-FREE-00999 freely available EZB journals</source><source>SAGE Complete</source><creator>De Ferrari, Gaetano M ; Fox, Keith AA ; White, Jennifer A ; Giugliano, Robert P ; Tricoci, Pierluigi ; Reynolds, Harmony R ; Hochman, Judith S ; Gibson, C Michael ; Théroux, Pierre ; Harrington, Robert A ; Van de Werf, Frans ; White, Harvey D ; Califf, Robert M ; Newby, L Kristin</creator><creatorcontrib>De Ferrari, Gaetano M ; Fox, Keith AA ; White, Jennifer A ; Giugliano, Robert P ; Tricoci, Pierluigi ; Reynolds, Harmony R ; Hochman, Judith S ; Gibson, C Michael ; Théroux, Pierre ; Harrington, Robert A ; Van de Werf, Frans ; White, Harvey D ; Califf, Robert M ; Newby, L Kristin</creatorcontrib><description>Aims:
Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.
Methods and results:
We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (ORadj 0.15; 95% CI, 0.11–0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (ORadj 0.19 (0.14–0.25) and 0.37 (0.28–0.49), respectively).
Conclusion:
Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872613489315</identifier><identifier>PMID: 24562802</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - surgery ; Coronary Angiography - methods ; Coronary Stenosis - diagnostic imaging ; Diagnosis, Differential ; Electrocardiography ; Female ; Follow-Up Studies ; Global Health ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Registries ; Survival Rate - trends</subject><ispartof>European heart journal. Acute cardiovascular care, 2014-03, Vol.3 (1), p.37-45</ispartof><rights>The European Society of Cardiology 2013</rights><rights>The European Society of Cardiology 2013 2013 European Society of Cardiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-a22e4168713445411db3792de19dfe7bd1970f67e407ce9426f4b29f4447e4dc3</citedby><cites>FETCH-LOGICAL-c434t-a22e4168713445411db3792de19dfe7bd1970f67e407ce9426f4b29f4447e4dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872613489315$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872613489315$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24562802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Ferrari, Gaetano M</creatorcontrib><creatorcontrib>Fox, Keith AA</creatorcontrib><creatorcontrib>White, Jennifer A</creatorcontrib><creatorcontrib>Giugliano, Robert P</creatorcontrib><creatorcontrib>Tricoci, Pierluigi</creatorcontrib><creatorcontrib>Reynolds, Harmony R</creatorcontrib><creatorcontrib>Hochman, Judith S</creatorcontrib><creatorcontrib>Gibson, C Michael</creatorcontrib><creatorcontrib>Théroux, Pierre</creatorcontrib><creatorcontrib>Harrington, Robert A</creatorcontrib><creatorcontrib>Van de Werf, Frans</creatorcontrib><creatorcontrib>White, Harvey D</creatorcontrib><creatorcontrib>Califf, Robert M</creatorcontrib><creatorcontrib>Newby, L Kristin</creatorcontrib><title>Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Aims:
Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.
Methods and results:
We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (ORadj 0.15; 95% CI, 0.11–0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (ORadj 0.19 (0.14–0.25) and 0.37 (0.28–0.49), respectively).
Conclusion:
Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - surgery</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Diagnosis, Differential</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Global Health</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Survival Rate - trends</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UUtv1DAQthCIVkvvnJCPHAj4MRsnHJBQRQGpUg-Us-U4k6yrxF5sZ9H-JP4l3m5ZFSR8GWvme4zmI-QlZ285V-qdYNA0StRcQtNKvn5Czg-tqlESnp7-oj4jFyndsfIUq6GRz8mZgHUtGibOya-bJdswY6JmDn6kPvjq222VcJzRZ4oT7kx2wVNjl4zUhhi8iXua9r6P97xtmRdooj9d3hQ-NX50YYxmu3HWTNOehi7luNjsdo8ETMxYSu8SmoTvDyCMR69EhyJNpXrDGT_pvyDPBjMlvHioK_L96tPt5Zfq-ubz18uP15UFCbkyQiDwulHlLLAGzvtOqlb0yNt-QNX1vFVsqBUCUxZbEPUAnWgHACi93soV-XDU3S7djL0t3tFMehvdXPbWwTj998S7jR7DTstWClVsV-T1g0AMPxZMWc8uWZwm4zEsSfM1440EAaJA2RFqY0gp4nCy4UwfQtb_hlworx6vdyL8ibQAqiMgmRH1XViiL-f6v-BvdOyzsg</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>De Ferrari, Gaetano M</creator><creator>Fox, Keith AA</creator><creator>White, Jennifer A</creator><creator>Giugliano, Robert P</creator><creator>Tricoci, Pierluigi</creator><creator>Reynolds, Harmony R</creator><creator>Hochman, Judith S</creator><creator>Gibson, C Michael</creator><creator>Théroux, Pierre</creator><creator>Harrington, Robert A</creator><creator>Van de Werf, Frans</creator><creator>White, Harvey D</creator><creator>Califf, Robert M</creator><creator>Newby, L Kristin</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140301</creationdate><title>Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients</title><author>De Ferrari, Gaetano M ; Fox, Keith AA ; White, Jennifer A ; Giugliano, Robert P ; Tricoci, Pierluigi ; Reynolds, Harmony R ; Hochman, Judith S ; Gibson, C Michael ; Théroux, Pierre ; Harrington, Robert A ; Van de Werf, Frans ; White, Harvey D ; Califf, Robert M ; Newby, L Kristin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-a22e4168713445411db3792de19dfe7bd1970f67e407ce9426f4b29f4447e4dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - surgery</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Diagnosis, Differential</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Global Health</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Survival Rate - trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>De Ferrari, Gaetano M</creatorcontrib><creatorcontrib>Fox, Keith AA</creatorcontrib><creatorcontrib>White, Jennifer A</creatorcontrib><creatorcontrib>Giugliano, Robert P</creatorcontrib><creatorcontrib>Tricoci, Pierluigi</creatorcontrib><creatorcontrib>Reynolds, Harmony R</creatorcontrib><creatorcontrib>Hochman, Judith S</creatorcontrib><creatorcontrib>Gibson, C Michael</creatorcontrib><creatorcontrib>Théroux, Pierre</creatorcontrib><creatorcontrib>Harrington, Robert A</creatorcontrib><creatorcontrib>Van de Werf, Frans</creatorcontrib><creatorcontrib>White, Harvey D</creatorcontrib><creatorcontrib>Califf, Robert M</creatorcontrib><creatorcontrib>Newby, L Kristin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Ferrari, Gaetano M</au><au>Fox, Keith AA</au><au>White, Jennifer A</au><au>Giugliano, Robert P</au><au>Tricoci, Pierluigi</au><au>Reynolds, Harmony R</au><au>Hochman, Judith S</au><au>Gibson, C Michael</au><au>Théroux, Pierre</au><au>Harrington, Robert A</au><au>Van de Werf, Frans</au><au>White, Harvey D</au><au>Califf, Robert M</au><au>Newby, L Kristin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>3</volume><issue>1</issue><spage>37</spage><epage>45</epage><pages>37-45</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Aims:
Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.
Methods and results:
We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (ORadj 0.15; 95% CI, 0.11–0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (ORadj 0.19 (0.14–0.25) and 0.37 (0.28–0.49), respectively).
Conclusion:
Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>24562802</pmid><doi>10.1177/2048872613489315</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal. Acute cardiovascular care, 2014-03, Vol.3 (1), p.37-45 |
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| source | MEDLINE; Oxford University Press Journals Current; EZB-FREE-00999 freely available EZB journals; SAGE Complete |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute Coronary Syndrome - surgery Coronary Angiography - methods Coronary Stenosis - diagnostic imaging Diagnosis, Differential Electrocardiography Female Follow-Up Studies Global Health Humans Male Middle Aged Percutaneous Coronary Intervention Prognosis Prospective Studies Registries Survival Rate - trends |
| title | Outcomes among non-ST-segment elevation acute coronary syndromes patients with no angiographically obstructive coronary artery disease: observations from 37,101 patients |
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