Non-Obstructive Coronaries In Patients Presenting With The Non St-Elevation Acute Coronary Syndrome
Shakir Zada1, Khalid Iqbal Bhatti1, Muhammad Zeb1
1National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
Insights
Non-obstructive coronary arteries are common in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). This study found 14.4% of NSTE-ACS patients had non-obstructive coronary arteries, highlighting a need for further research.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cardiovascular diseases are a leading cause of mortality globally.
- Acute coronary syndrome (ACS) is a common manifestation, with non-ST elevation ACS (NSTE-ACS) accounting for 70% of cases.
- NSTE-ACS often involves partial or intermittent coronary artery occlusion, necessitating investigation into non-obstructive causes.
Purpose of the Study:
- To determine the prevalence and characteristics of non-obstructive coronary arteries in patients with NSTE-ACS.
- To investigate the demographic and clinical factors associated with non-obstructive coronary arteries in this patient cohort.
- To contribute to understanding NSTE-ACS in a Pakistani population.
Main Methods:
- A descriptive cross-sectional study was conducted at a tertiary care cardiac center.
- Included were 174 patients aged 30-70 years admitted with NSTE-ACS.
- Coronary angiography was used to identify non-obstructive coronary arteries (absence of ≥50% stenosis).
Main Results:
- The study included 174 patients (56.9% male, mean age 59.43±11.24 years).
- Prevalent comorbidities included hypertension (43.7%), hyperlipidemia (31.6%), and chronic kidney disease (11.5%).
- Non-obstructive coronary arteries were identified in 25 patients (14.4%).
Conclusions:
- Non-obstructive coronary arteries are a significant finding in patients presenting with NSTE-ACS in this population.
- The prevalence of 14.4% underscores the importance of considering non-obstructive causes in NSTE-ACS.
- Further research is recommended to elucidate pathophysiology and optimize management for non-obstructive coronary artery disease (NOCA) in NSTE-ACS.
Background:
Worldwide, cardiovascular diseases are the major cause of mortality and morbidity with acute coronary syndrome as the most common clinical manifestation. In a typical clinical setup, around 30% of the patients presented with "ST-segment elevation myocardial infarction (STEMI)" caused by the complete occlusion of the coronary artery and the remaining 70% with intermittent or partial occlusion of the coronary termed as non-ST elevation The aim of this study was to assess the prevalence and characteristics of non-obstructive coronary arteries among patients presenting with non ST-elevation acute coronary syndrome (NSTE-ACS) at a tertiary care cardiac center of Karachi, Pakistan.
Methods:
This was a descriptive cross-sectional study, conducted at a tertiary care hospital in Karachi. Study inclusion criteria were patients of either gender admitted with NSTE-ACS and aged between 30-70 years. A routine coronary angiogram was performed in all the patients and the absence of ≥50% stenosis in any major epicardial vessel was taken in non-obstructive coronaries.
Results:
A total of 174 patients (30-70 years) were included, of which 99 (56.9%) were male and the mean age was 59.43±11.24 years. In the distribution of socioeconomic status, 54 (31.0%) were lower class, middle class 81 (46.6%) while upper-class status were 39 (22.4%). Hypertension was observed in 76 (43.7%), chronic kidney disease in 20 (11.5%), and hyperlipidemia in 55 (31.6%). Non-obstructive coronary arteries were noted in 25 (14.4%) patients.
Conclusions:
It is to be concluded that non-obstructive coronary arteries are fairly prevalent in patients arriving in hospitals with NSTE-ACS in our population. Further research is needed to better understand the underlying pathophysiology and optimal management strategies for patients with NOCA in the setting of NSTEMI.
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