Long-Term Prognosis of Patients with Acute Coronary Syndrome and Moderate Coronary Artery Stenosis

Abstract

We evaluated the clinical outcome and the prognostic factors at 6-year follow-up of patients with acute coronary syndrome without critical coronary arterial narrowing. The mean follow-up was 73 ± 19 months. Mortality rate was 13%, and 20 patients (12%) had major cardiac event, 8 patients (5%) had stroke and 10 patients (6%) underwent revascularization. Multivariate analysis matched for age and ejection factor showed that moderate disease (stenosis 40–59%) (OR = 2.713, p < 0.024) was an independent predictive factor of major cardiac event.

Low utilisation of cardiovascular risk reducing therapy in patients with acute coronary syndromes and non-obstructive coronary artery disease

“…Also, the sample size was too small to evaluate differences in clinical characteristics and outcome between patients with completely normal coronary angiograms and those with minor CAD. The majority of patients with NOCAD in our study had minor CAD and these patients have been shown to have a higher risk of subsequent clinical events compared to patients with completely normal coronary arteries [6,7]. It is also true that coronary lesions may not always be reliably detected by coronary angiography [27].…”

“…One study revealed a 2% in-hospital risk of death or myocardial infarction in patients with NOCAD presenting with unstable angina (UA) or non-Q-wave myocardial infarction (MI) [5], while in a larger study a 2% 12-month rate of death or MI and a 12% composite event rate was found in similar patients after non-ST elevation ACS [6]. A study with much longer follow-up of such patients noted a 13% mortality and 12% major coronary event rate at 6 years [7]. It is likely that aggressive risk factor reduction may improve outcome, but utilisation of preventative medical therapy in this subset of ACS patients has not been well characterised.…”