De Ferrari Gaetano M, Fox Keith A A, White Jennifer A, Giugliano Robert P, Tricoci Pierluigi, Reynolds Harmony R, Hochman Judith S, Gibson C Michael, Théroux Pierre, Harrington Robert A, Van de Werf Frans, White Harvey D, Califf Robert M, Newby L Kristin
Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Eur Heart J Acute Cardiovasc Care. 2014 Mar;3(1):37-45. doi: 10.1177/2048872613489315. Epub 2013 May 9.
Limited data exist concerning outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) with no angiographically obstructive coronary artery disease (non-obstructive CAD). We assessed the frequency of clinical outcomes among patients with non-obstructive CAD compared with obstructive CAD.
We pooled data from eight NSTE ACS randomized clinical trials from 1994 to 2008, including 37,101 patients who underwent coronary angiography. The primary outcome was 30-day death or myocardial infarction (MI). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day death or MI for non-obstructive versus obstructive CAD were generated for each trial. Summary ORs (95% CIs) across trials were generated using random effects models. Overall, 3550 patients (9.6%) had non-obstructive CAD. They were younger, more were female, and fewer had diabetes mellitus, previous MI or prior percutaneous coronary intervention than patients with obstructive CAD. Thirty-day death or MI was less frequent among patients with non-obstructive CAD (2.2%) versus obstructive CAD (13.3%) (OR(adj) 0.15; 95% CI, 0.11-0.20); 30-day death or spontaneous MI and six-month mortality were also less frequent among patients with non-obstructive CAD (OR(adj) 0.19 (0.14-0.25) and 0.37 (0.28-0.49), respectively).
Among patients with NSTE ACS, one in 10 had non-obstructive CAD. Death or MI occurred in 2.2% of these patients by 30 days. Compared with patients with obstructive CAD, the rate of major cardiac events was lower in patients with non-obstructive CAD but was not negligible, prompting the need to better understand management strategies for this group.
关于无血管造影显示冠状动脉阻塞性疾病（非阻塞性CAD）的非ST段抬高型急性冠状动脉综合征（NSTE ACS）患者的预后数据有限。我们评估了非阻塞性CAD患者与阻塞性CAD患者临床结局的发生频率。
我们汇总了1994年至2008年八项NSTE ACS随机临床试验的数据，包括37101例行冠状动脉造影的患者。主要结局为30天死亡或心肌梗死（MI）。为每项试验生成非阻塞性CAD与阻塞性CAD的30天死亡或MI的调整优势比（OR）和95%置信区间（CI）。使用随机效应模型生成各试验的汇总OR（95%CI）。总体而言，3550例患者（9.6%）患有非阻塞性CAD。与阻塞性CAD患者相比，他们更年轻，女性更多，糖尿病、既往MI或既往经皮冠状动脉介入治疗的患者更少。非阻塞性CAD患者30天死亡或MI的发生率（2.2%）低于阻塞性CAD患者（13.3%）（调整后OR 0.15；95%CI，0.11 - 0.20）；非阻塞性CAD患者30天死亡或自发性MI以及六个月死亡率也较低（调整后OR分别为0.19（0.14 - 0.25）和0.37（0.28 - 0.49））。
在NSTE ACS患者中，十分之一的患者患有非阻塞性CAD。这些患者中有2.2%在30天内发生死亡或MI。与阻塞性CAD患者相比，非阻塞性CAD患者的主要心脏事件发生率较低，但并非可以忽略不计，这促使我们需要更好地了解该组患者的管理策略。
