ABSTRACT
INTRODUCTION:
Coronary
sclerosis is a
risk factor for the progression to obstructive
coronary artery disease (CAD). However,
understanding its impact on the outcomes of
patients with
myocardial infarction and non-obstructive
coronary arteries is limited. This study aimed to explore the prognostic influence of coronary
sclerosis on in- and out-of-
hospital events in
troponin-positive
patients with non-obstructive
coronary arteries.
METHODS:
This study was a retrospective
cohort analysis based on prospectively collected data. A total of 24,775
patients who underwent
coronary angiography from 2010 to 2021 in a German
university hospital were screened, resulting in a final study cohort of 373
troponin-positive
patients with non-obstructive
coronary arteries and a follow-up period of 6.2 ± 3.1 years. Coronary
sclerosis was defined as coronary plaques without angiographically detectable stenotic lesions of 50% or more in the large epicardial
coronary arteries. The primary study endpoint was the occurrence of in-
hospital events.
Secondary endpoints included events during follow-up.
RESULTS:
Patients with coronary
sclerosis were significantly older (70 ± 12 vs. 58 ± 16 years, p < 0.001), had ST-segment elevation less frequently on
electrocardiogram (9.4% vs. 18.7%, p = 0.013), and suffered more often from
diabetes mellitus (23.3% vs. 13.1%, p = 0.009), arterial
hypertension (79.6% vs. 59.8%, p < 0.001),
chronic obstructive pulmonary disease (17.1% vs. 9.4%, p = 0.028),
chronic kidney disease (22.2% vs. 8.4%, p < 0.001),
atrial fibrillation (19.8% vs. 12.2%, p = 0.045), and valvular
diseases than
patients without CAD.
Patients with coronary
sclerosis were more likely to receive medication for primary/
secondary prevention on admission and at discharge. The
incidence of in- and out-of-
hospital events was significantly higher in
patients with coronary
sclerosis (in-
hospital 42.8% vs. 29.9%, p = 0.010; out-of-
hospital 46.0% vs. 26.1%, p < 0.001).
Mortality rates tended to be higher in the coronary
sclerosis group (29.4% vs. 20.0%, p = 0.066).
CONCLUSION:
Patients diagnosed with coronary
sclerosis presented a higher
incidence of comorbidities and increased medication use, and experienced higher rates of both in-
hospital and out-of-
hospital events, primarily due to the
clustering of
cardiovascular risk factors.