Table 5 - uploaded by Nancy Wassef
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Introduction
Troponin elevation is an independent risk factor for mortality, but the prognosis of patients with troponin elevation and non-obstructive coronary artery disease (CAD) is unknown. Recent data have suggested an increased risk of mortality. This study was performed to further investigate the outcomes of troponin-positive patients with o...
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Aims
High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI.
Methods and results
We e...
Citations
... According to other studies, NOCAD patients may disclose a cTnI-levels increase [71] or its absence [72][73][74], the same as in our analysis. Moreover, higher troponin levels were observed in OCAD than in the NOCAD group [75][76][77], and correspondingly increased values of cTnI were more common in patients with OCAD (66%) than NOCAD (40%) [71]. ...
... Interestingly, patients with NOCAD who presented a significant increase in troponin due to a specific non-myocardial cause were at the same risk of death and MACE as patients with OCAD and elevated troponins during the 1-year follow-up [76]. On the other hand, NOCAD patients with an unidentified origin of raised troponins were in the low-risk group [75]. A study by Aldous et al. also showed that patients without CAD or with NOCAD, presenting with angina-like pain and elevated troponin values, were at low risk of death and heart attack during the 2-year follow-up [62]. ...
... However, in neither of these studies was the predominance of patients without arterial hypertension in the NOCAD group as significant as in our study. In contrast to our research, a few studies reported that most NOCAD patients presented with coexisting arterial hypertension [66,75] or that groups of patients with and without hypertension were comparable [71]. ...
No hemodynamically significant atherosclerotic plaques are observed in up to 30% of patients reporting angina and undergoing coronary angiography. To investigate risk factors associated with non-obstructive coronary artery disease (NOCAD), we analyzed the medical records of, consecutively, 136 NOCAD subjects and 128 patients with significant stenosis in at least one coronary artery (the OCAD group). The blood concentrations of the TC (4.40 [3.78–5.63] mmol/L vs. 4.12 [3.42–5.01] mmol/L; p = 0.026), LDL-C (2.32 [1.80–3.50] mmol/L vs. 2.10 [1.50–2.70] mmol/L; p = 0.003), non-HDL-C (2.89 [2.29–4.19] mmol/L vs. 2.66 [2.06–3.39] mmol/L; p = 0.045), as well as the LDL-C/HDL-C ratio (1.75 [1.22–2.60] vs. 1.50 [1.10–1.95]; p = 0.018) were significantly increased in the NOCAD patients compared to the OCAD group due to the lower prevalence and intensity of the statin therapy in the NOCAD individuals (p < 0.001). Moreover, the abovementioned lipid parameters appeared to be valuable predictors of NOCAD, with the LDL-C (OR = 1.44; 95%CI = 1.14–1.82) and LDL-C/HDL-C (OR = 1.51; 95%CI = 1.13–2.02) showing the highest odds ratios. Furthermore, multivariable logistic regression models determined female sex as the independent risk factor for NOCAD (OR = 2.37; 95%CI = 1.33–4.20). Simultaneously, arterial hypertension substantially lowered the probability of NOCAD (OR = 0.21; 95%CI = 0.10–0.43). To conclude, female sex, the absence of arterial hypertension, as well as increased TC, LDL-C, non-HDL, and LDL-C/HDL-C ratio are risk factors for NOCAD in patients reporting angina, potentially as a result of poor hypercholesterolemia management.
... Eine Sekundärprophylaxe dieser Patientengruppe, die den Krankheitsverlauf positiv beeinflusst, sollte in Betracht gezogen werden (ebd.).beobachten, diskutieren als Gründe für eine höhere Mortalität "eine rupturierte instabile Plaque", die sich als nicht signifikant in der Koronarangiographie gezeigt hat"(Mehta et al., 2007, S.624). Andere Mechanismen, wie ein "endothelial leckage" oder eine mikrovaskuläre Gefäßläsion sind denkbar und wurden diskutiert(Patil et al. 2011, S.723).Planer et al. spekulieren diesbezüglich, ob eine frühzeitig eingeleitete antithrombotische Therapie sogar eine instabile Plaque mit thrombotischen Auflagerungen maskieren und in der anschließenden Koronarangiographie als nicht signifikant erscheinen lassen kann(Planer et al., 2014, S.291).Die dargestellten Erkenntnisse zeigen, dass die Patienten mit NSTE-ACS ohneKoronarobstruktion nicht wie bisher angenommen eine Niedrigrisikogruppe darstellen(Wassef et al., 2014). "Formen der Sekundärprophylaxe, die einen malignen Krankheitsverlauf abwenden, wie eine engmaschige Beobachtung", sind zu überdenken und einzuleiten(Planer et al.20, S.291). ...
... After a 21 months follow-up [19], the cumulative MACE rate was 0.5% for normal CTA patients, 3.5% for non-obstructive CAD and 16% for obstructive CAD. Wassef et al. [20] found that troponin positive patients with non-obstructive CAD had a similar risk to the obstructive-CAD patients for MACE and mortality after a 30 days follow-up. However, after a 1-year follow-up, indications showed a higher mortality and MACE for those patients with troponin positive non-obstructive than with obstructive CAD. ...
The characteristics of coronary stenosis vary among the different countries or areas. 11,267 patients who have undergone coronary angiography (CAG) from three Southwest China hospitals were investigated. Patient characteristics, coronary stenosis and stent-implant information were recorded and analyzed according to two criteria: “visible stenosis” and “≥ 50% stenosis”. The patients who have undergone CAG increased year by year, with patients from 60 to 69 years-old taking the highest ratio (34.69%). Based on the “≥ 50% stenosis” criteria, the stenotic frequency was 40.54% for Southwest China patients getting CAG. Only 8.14% patients suffered ≥ 3 stenotic vessels, while 11.58 and 20.82% patients had 2 or 1 stenotic vessel, respectively. However, when using the “visible stenosis” criteria, the stenotic frequency increased to 64.68%. The prevalence of stenosis increased with age based on the “visible stenosis” criteria. There were more male patients with stenosis than female except patients over 80 years old. The stenosis affected almost all main coronary arteries and their branches, with the most affected artery being the left anterior descending artery. There were 3246 cases (28.8%) implanted with 5423 stents with a concurrent age-dependent increasing tendency for stent-implant frequency and average implanted stent number. The numbers of patients who have undergone CAG and suffered from CVD increased rapidly. In these patients, positive rate of CAG was 64.67%, which increased to 72.2% in patients over 60-years old. The incidence of ≥ 75% stenosis and multiple stenosis increased with age, however it should be noticed there were 18.93% for ≥ 75% stenosis and 19.52% for multiple stenosis in patients under 40 years old.
... In the Literature, there are numerous cases of patient clinically presenting with myocardial infarction (MI), acute coronary syndrome (ACS) or vasospastic angina, in the meanings of "X syndrome", primary angina or Printzmetal variant showing angiographic non-obstructive coronary artery disease (NOCAD). According to previous studies, NOCAD is associated with a rate of major adverse cardiovascular events equal to obstructive CAD [2,3]. ...
... NOCAD has been angiographically defined how less than 50% stenosis of luminal diameter [2]. Previous authors have reported that as many as 10% of myocardial infarction (MI) patients have evidence of NOCAD [2][3][4]. In this view, although many limitations and gaps are present in current knowledge how they have affirmed, much has been understood thanks to intravascular ultrasound (IVUS has a spatial resolution of 150 μm) as well as optical coherence tomography (OCT has a spatial resolution of 10-20 μm). ...
