Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) initiative
Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) initiative
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DOI：
10.1016/j.ahj.2006.02.035
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发表时间：
2006-10-01
影响因子：
4.8
通讯作者：
Roe, Matthew T.
中科院分区：
文献类型：
--
作者：
Patel, Manesh R.;Chen, Anita Y.;Roe, Matthew T.
背景与ST段抬高心肌梗死不同，非ST段抬高心肌梗死(NSTEMI)患者的狭窄程度和缺血生理状态各不相同。在常规临床实践中缺乏明显的心外膜冠状动脉病变(CAD)的NSTEMI患者的患病率、预测因素和结果仍然缺乏特征性。我们试图确定NSTEMI和微不足道的冠心病患者的患病率、预测因素和预后。方法我们分析了38 301名接受心导管术的非STEMI患者，这些患者接受了心导管术，以确定合并和不合并CAD的患者的患病率和相关因素(所有冠状动脉狭窄均为50%)和住院结果。结果38301例患者中有3,306例(8.6%)存在无意义冠心病。女性(优势比2.8，95%可信区间2.6~3.1)、较年轻年龄(每10年优势比下降1.5，95%可信区间1.5~1.6)和不吸烟(优势比1.9，95%可信区间1.7~2.0)是无意义冠心病的最强多变量预测因素。无意义冠心病患者的住院死亡率为0.65%，而冠心病患者的住院死亡率为2.36%(P<；.0001)。结论非ST段抬高心肌梗死患者中有9%存在无意义冠心病，且与不良结果发生率低有关。女性和较年轻的年龄是无关紧要的冠心病的最强预测者。这些发现强调了研究了解这一人群中心肌梗死的病理生理学的必要性。
Background Unlike ST-segment elevation myocardial infarction, the degree of stenosis and physiology of ischemia varies in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The prevalence, predictors, and outcomes of patients with NSTEMI who lack significant epicardial coronary artery disease (CAD) in routine clinical practice remain poorly characterized. We sought to determine the prevalence, predictors, and outcomes of patients with NSTEMI and insignificant CAD.Methods We analyzed 38 301 patients with NSTEMI in the CRUSADE quality improvement initiative who underwent cardiac catheterization to determine the prevalence and factors associated with insignificant CAD (all coronary stenoses < 50%) and inhospital outcomes for patients with and without CAD. A multivariable model was used to determine the factors associated with insignificant CAD.Results A total of 3306 (8.6%) of 38301 patients had insignificant CAD. The strongest multivariable predictors of insignificant CAD were female sex (odds ratio 2.8, 95% CI 2.6-3.1), younger age (odds ratio per 10-year decrease 1.5, 95% CI 1.5-1.6), and lack of current/recent smoking (odds ratio 1.9, 95% CI 1.7-2.0). Inhospital rates of death were 0.65% for patients with insignificant CAD compared with 2.36% for patients with CAD (P < .0001).Conclusion Insignificant CAD is present in 9% of patients with NSTEMI and is associated with a low incidence of adverse outcomes. The strongest predictors of insignificant CAD are female sex and younger age. These findings underscore the need for research to understand the pathophysiology of myocardial infarction in this population.