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Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography Bugiardini R; Manfrini O; De Ferrari GMArch Intern Med 2006[Jul]; 166 (13): 1391-5BACKGROUND: The prognostic implication of chest pain associated with normal or near-normal findings on angiography is still unknown. We explored outcomes and methods of risk stratification in patients with nonobstructive coronary artery disease in the setting of non-ST-segment elevation acute coronary syndromes. METHODS: Data were pooled from 3 Thrombolysis in Myocardial Infarction (TIMI) trials (TIMI 11B, TIMI 16, and TIMI 22). Angiographic data were available on 7656 patients with non-ST-segment elevation acute coronary syndromes. The primary end point of this analysis was the composite of the rates of death, myocardial infarction, unstable angina requiring rehospitalization, revascularization, and stroke at 1-year follow-up. Outcomes were evaluated by mean of the TIMI risk score for developing at least 1 component of the primary end point. RESULTS: Angiographic findings showed that 710 (9.1%) of 7656 patients had nonobstructive coronary artery disease; 48.7% of these had normal coronary arteries (0% stenosis), and 51.3% had mild coronary artery disease (>0% to <50% stenosis). A primary end-point event occurred in 101 patients (12.1%). It is noteworthy that a 2% event rate of deaths and myocardial infarctions had occurred in these patients at the 1-year follow-up. Event rates of death and myocardial infarction increased significantly as the TIMI risk score increased from 0.6% for a score of 1 to 4.0% for a score greater than 4. CONCLUSIONS: Patients with non-ST-segment elevation acute coronary syndromes with nonobstructive coronary artery disease detected by angiography have a substantial risk of subsequent coronary events within 1 year. The risk is not univariately high, and the TIMI risk score helps to reveal patients at high risk.|*Coronary Angiography[MESH]|*Outcome Assessment, Health Care[MESH]|*Risk Assessment[MESH]|Angina, Unstable/*epidemiology[MESH]|Coronary Artery Disease/diagnostic imaging/epidemiology[MESH]|Coronary Stenosis/diagnostic imaging/epidemiology[MESH]|Electrocardiography[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Hospitalization/statistics & numerical data[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Myocardial Infarction/*epidemiology[MESH]|Myocardial Revascularization/statistics & numerical data[MESH]|Prognosis[MESH]|Randomized Controlled Trials as Topic[MESH]|Stroke/epidemiology[MESH] |
