American Heart Journal
Volume 152, Issue 4 , Pages 641-647, October 2006

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

  • Manesh R. Patel, MD

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • Corresponding Author InformationReprint requests: Manesh R. Patel, MD, PO Box 17969, Duke Clinical Research Institute, Durham, NC 27705.
    • ,
  • Anita Y. Chen, MS

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Eric D. Peterson, MD, MPH

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • L. Kristin Newby, MD, MHS

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Charles V. Pollack Jr., MD, MA

      Affiliations

    • Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Ralph G. Brindis, MD, MPH

      Affiliations

    • San Francisco Kaiser Permanente Hospital, San Francisco, CA
    • ,
  • C. Michael Gibson, MD

      Affiliations

    • Harvard Clinical Research Institute, Boston, MA
    • ,
  • Neal S. Kleiman, MD

      Affiliations

    • Section of Cardiology, Baylor College of Medicine, Oklahoma City, OK
    • ,
  • Jorge F. Saucedo, MD

      Affiliations

    • University of Oklahoma Health Sciences Center, Oklahoma City, OK
    • ,
  • Deepak L. Bhatt, MD

      Affiliations

    • Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
    • ,
  • W. Brian Gibler, MD

      Affiliations

    • University of Cincinnati School of Medicine, Cincinnati, OH
    • ,
  • E. Magnus Ohman, MD

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Robert A. Harrington, MD

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Matthew T. Roe, MD, MHS

      Affiliations

    • Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

Received 17 June 2005; accepted 5 February 2006. published online 30 June 2006.

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 38301 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.

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 CRUSADE is a national quality improvement initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb, New York, NY/Sanofi-Aventis Pharmaceuticals, Paris, France. Partnership provides additional funding support. Millennium Pharmaceuticals, Inc., Cambridge, MA, also funded this work.

PII: S0002-8703(06)00254-7

doi:10.1016/j.ahj.2006.02.035

American Heart Journal
Volume 152, Issue 4 , Pages 641-647, October 2006

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