Patients with acute coronary syndrome and nonobstructive coronary artery disease in the real world are markedly undertreated.
J Cardiovasc Med (Hagerstown)
; 12(10): 700-8, 2011 Oct.
Article
em En
| MEDLINE
| ID: mdl-21738050
ABSTRACT
OBJECTIVES:
We assessed the clinical profile of patients with acute coronary syndrome (ACS) and nonobstructive coronary artery disease (CAD) in a real world setting, focusing on pattern of care and on prognosis.METHODS:
Each nonobstructive CAD (<50% stenosis in any epicardial coronary artery) patient was matched with an obstructive CAD patient; adjusted estimates of prescription of guideline-recommended drugs at discharge and of long-term prognosis were evaluated.RESULTS:
Among 2995 consecutive ACS patients who underwent coronary angiography, 125 (4.2%) had nonobstructive CAD. Nonobstructive CAD patients had significantly lower odds of receiving aspirin [odds ratio (OR) 0.31, 95% confidence interval (CI) 0.14-0.68], thienopyridines (OR 0.01, 95% CI 0.00-0.07), statins (OR 0.31, 95% CI 0.17-0.58), beta-blockers (OR 0.32, 95% CI 0.17-0.63) and angiotensin converting enzyme-inhibitors /angiotensin receptor blockers (OR 0.36, 95% CI 0.17-0.91) compared with matched patients. During a 3-year follow-up, nonobstructive CAD patients had significantly fewer cardiovascular deaths and myocardial infarctions but numerically more episodes of unstable angina.CONCLUSIONS:
The prevalence of nonobstructive CAD appears lower (4.2%) compared with published data. After extensive adjustment, patients with nonobstructive CAD were significantly less likely to be treated with guideline-recommended therapy, including aspirin and statins. Multicenter prospective studies targeting this specific population and the potential benefit of guideline-recommended therapies appear warranted.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
11_ODS3_cobertura_universal
Base de dados:
MEDLINE
Assunto principal:
Padrões de Prática Médica
/
Fármacos Cardiovasculares
/
Estenose Coronária
/
Síndrome Coronariana Aguda
/
Oclusão Coronária
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Cardiovasc Med (Hagerstown)
Ano de publicação:
2011
Tipo de documento:
Article