Background
Non-obstructive coronary artery disease (CAD) on coronary angiography after myocardial
infarction (MI) is associated with a lower risk of adverse outcomes, but the prognosis
may not be benign. Our aim was to assess outcomes in MI with and without obstructive
CAD, and in an age and sex matched comparison cohort without known cardiovascular
disease.
Methods
We performed a single centre analysis of consecutive patients undergoing coronary
angiography for MI between 2007 and 2012. Patients were classified into those with
obstructive CAD (≥ 50% epicardial coronary artery stenosis) and those without obstructive CAD (<50%).
Myocardial infarction patient data was collected in an electronic registry and linked
anonymously to national hospitalisation and mortality records. Age and sex matched
patients without known CVD were identified from the community PREDICT cohort.
Results
Of the 2070 patients with MI, 302 (15%) had non-obstructive CAD. Compared to patients
with obstructive disease they were younger (mean 57 v 61 years, p < 0.001), more likely to be women (50% vs 23%, p < 0.001), to be of Maori or Pacific vs. European ethnicity (p < 0.001), more likely to be lifelong non-smokers (46% v 38%, p = 0.02), non-diabetic (80 v 73%, p < 0.01), have no ST-segment deviation (78% v 46%, p < 0.001), and have a low risk Global Registry of Acute Coronary Events acute coronary
syndrome (GRACE ACS) score (54 v 35%, p < 0.001). They were also less likely to receive ‘triple therapy’ secondary prevention
medications (81% v 94%, p < 0.0001). The cumulative two-year Kaplan-Maier composite outcome of mortality or non-fatal
MI was 14.3% for MI with obstructive CAD, 4.6% for MI without obstructive disease,
and 2.2% for patients without prior CVD (p < 0.001).
Conclusion
Myocardial infarction without obstructive coronary disease is common (∼1 in 7 patients)
and is not clinically benign, with an adverse outcome rate double that of age and
sex matched patients without CVD.
Keywords
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Article info
Publication history
Published online: March 29, 2017
Accepted:
February 16,
2017
Received in revised form:
December 28,
2016
Received:
August 7,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
