Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease
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Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease. / Andersson, Hedvig Bille; Pedersen, Frants; Engstrøm, Thomas; Helqvist, Steffen; Jensen, Morten Kvistholm; Jørgensen, Erik; Kelbæk, Henning; Räder, Sune Bernd Emil Werner; Saunamäki, Kari; Bates, Eric; Grande, Peer; Holmvang, Lene; Clemmensen, Peter.
In: EUR HEART J, Vol. 39, No. 2, 07.01.2018, p. 102-110.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease
AU - Andersson, Hedvig Bille
AU - Pedersen, Frants
AU - Engstrøm, Thomas
AU - Helqvist, Steffen
AU - Jensen, Morten Kvistholm
AU - Jørgensen, Erik
AU - Kelbæk, Henning
AU - Räder, Sune Bernd Emil Werner
AU - Saunamäki, Kari
AU - Bates, Eric
AU - Grande, Peer
AU - Holmvang, Lene
AU - Clemmensen, Peter
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.
PY - 2018/1/7
Y1 - 2018/1/7
N2 - Aims: We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD).Methods and results: We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with non-obstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population.Conclusions: STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.
AB - Aims: We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD).Methods and results: We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with non-obstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population.Conclusions: STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.
KW - Acute Coronary Syndrome/diagnosis
KW - Adult
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Cause of Death
KW - Coronary Angiography
KW - Coronary Artery Disease/diagnosis
KW - Denmark
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Sex Factors
KW - Survivors
KW - Troponin T/blood
U2 - 10.1093/eurheartj/ehx491
DO - 10.1093/eurheartj/ehx491
M3 - SCORING: Journal article
C2 - 29029035
VL - 39
SP - 102
EP - 110
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 2
ER -
