正常或接近正常冠状动脉、非阻塞性或阻塞性冠状动脉疾病患者的临床特征、性别差异和结局。

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near-Normal Coronary Arteries, Non-Obstructive or Obstructive Coronary Artery Disease.

机构信息

Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA.

Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA

出版信息

J Am Heart Assoc. 2018 May 2;7(10):e007965. doi: 10.1161/JAHA.117.007965.

BACKGROUND

Normal or near-normal coronary arteries (NNCAs) or nonobstructive coronary artery disease (CAD) are found on invasive coronary angiography in ≈55% of patients. Some attribute this to frequent referral of low-risk patients. We sought to identify the referral indications, pretest risk, key clinical characteristics, sex, and outcomes in patients with NNCAs and nonobstructive CAD versus obstructive CAD on nonemergent invasive coronary angiography.

METHODS AND RESULTS

Over 24 months, 925 consecutive patients were classified as having NNCAs (≤20% stenosis), nonobstructive CAD (21-49% stenosis), or obstructive CAD (≥50% stenosis). Outcomes included cardiac death, nonfatal myocardial infarction, and late revasclarization. NNCAs were found in 285 patients (31.0%), nonobstructive CAD in 125 (13.5%), and obstructive CAD in 513 (55.5%). NNCAs or nonobstructive CAD was found in 40.5% with stress ischemia, 27.9% after a non-ST-elevation myocardial infarction, and in 55.5% with stable or unstable angina. More women than men (53.5% versus 37.2%; <0.001) had NNCAs or nonobstructive CAD across all referral indications. Pretest risk was high and ICA appropriate in 75.5% and 99.2% of patients, respectively. Annual rates of cardiac death or nonfatal myocardial infarction were 1.0%, 1.1%, and 6.7%, respectively, for patients with NNCAs, nonobstructive CAD, and obstructive CAD (<0.001). No sex differences in outcomes were observed with either NNCAs, nonobstructive CAD, or obstructive CAD (=0.84).

CONCLUSIONS

Many (44.5%) patients undergoing nonemergent invasive coronary angiography have NNCAs or nonobstructive CAD despite high pretest risk, including ischemia and troponin elevation. Although women had more NNCAs or nonobstructive CAD, there were no differences in event rates by sex. Patients with NNCAs and nonobstructive CAD had very low event rates.

背景

在约 55%的接受有创冠状动脉造影检查的患者中发现正常或近乎正常的冠状动脉（NNCAs）或非阻塞性冠状动脉疾病（CAD）。有人认为这是由于频繁转诊低危患者所致。我们旨在确定非紧急有创冠状动脉造影检查中 NNCAs 和非阻塞性 CAD 与阻塞性 CAD 患者的转诊指征、术前风险、主要临床特征、性别和结局。

方法和结果

在 24 个月期间，925 例连续患者被分为 NNCAs（狭窄程度≤20%）、非阻塞性 CAD（狭窄程度 21-49%）或阻塞性 CAD（狭窄程度≥50%）。结局包括心源性死亡、非致死性心肌梗死和晚期血运重建。285 例患者存在 NNCAs（31.0%），125 例患者存在非阻塞性 CAD（13.5%），513 例患者存在阻塞性 CAD（55.5%）。在有应激缺血的患者中发现 40.5%存在 NNCAs 或非阻塞性 CAD，在非 ST 段抬高型心肌梗死患者中发现 27.9%存在 NNCAs 或非阻塞性 CAD，在稳定或不稳定型心绞痛患者中发现 55.5%存在 NNCAs 或非阻塞性 CAD。各转诊指征中女性患者（53.5%比 37.2%；<0.001）均多于男性。分别有 75.5%和 99.2%的患者存在高术前风险和适当的 ICA。NNCAs、非阻塞性 CAD 和阻塞性 CAD 患者的年心源性死亡或非致死性心肌梗死发生率分别为 1.0%、1.1%和 6.7%（<0.001）。在 NNCAs、非阻塞性 CAD 或阻塞性 CAD 中，未见任何性别差异与结局相关（=0.84）。