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Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial.

Publication ,  Journal Article
Planer, D; Mehran, R; Ohman, EM; White, HD; Newman, JD; Xu, K; Stone, GW
Published in: Circ Cardiovasc Interv
June 2014

BACKGROUND: Troponin elevation is a risk factor for mortality in patients with non-ST-segment-elevation acute coronary syndromes. However, the prognosis of patients with troponin elevation and nonobstructive coronary artery disease (CAD) is unknown. Our objective was therefore to evaluate the impact of nonobstructive CAD in patients with non-ST-segment-elevation acute coronary syndromes and troponin elevation enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. METHODS AND RESULTS: In the ACUITY trial, 3-vessel quantitative coronary angiography was performed in a formal substudy of 6921 patients presenting with non-ST-segment-elevation acute coronary syndromes. Patients with elevated admission troponin levels were stratified by the presence or absence of obstructive CAD (any lesion with quantitative diameter stenosis >50%). Propensity score matching was performed to adjust for baseline characteristics. Of 2442 patients with elevated troponin, 197 (8.8%) had nonobstructive CAD. Maximum diameter stenosis was 87.4 (73.2, 100.0) versus 22.6 (19.2, 25.7; P<0.0001) in patients with versus without obstructive CAD, respectively. Propensity matching yielded 117 patients with nonobstructive CAD and 331 patients with obstructive CAD, with no significant baseline differences between groups. In the matched cohort, overall 1-year mortality was significantly higher in patients with nonobstructive CAD (5.2% versus 1.6%; hazard ratio [95% confidence interval]=3.44 [1.05, 11.28]; P=0.04), driven by greater noncardiac mortality. Conversely, recurrent myocardial infarction and unplanned revascularization rates were significantly higher in patients with obstructive CAD. CONCLUSIONS: Patients with non-ST-segment-elevation acute coronary syndromes and elevated troponin levels but without obstructive CAD, while having low rates of subsequent myocardial infarction and unplanned revascularization, are still at considerable risk for 1-year mortality from noncardiac causes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

June 2014

Volume

7

Issue

3

Start / End Page

285 / 293

Location

United States

Related Subject Headings

  • Troponin
  • Triage
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

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ICMJE
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Planer, D., Mehran, R., Ohman, E. M., White, H. D., Newman, J. D., Xu, K., & Stone, G. W. (2014). Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circ Cardiovasc Interv, 7(3), 285–293. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000606
Planer, David, Roxana Mehran, E Magnus Ohman, Harvey D. White, Jonathan D. Newman, Ke Xu, and Gregg W. Stone. “Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial.Circ Cardiovasc Interv 7, no. 3 (June 2014): 285–93. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000606.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

June 2014

Volume

7

Issue

3

Start / End Page

285 / 293

Location

United States

Related Subject Headings

  • Troponin
  • Triage
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Myocardial Infarction
  • Middle Aged
  • Male