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Prognostic Implications of Coronary Artery Sclerosis in Troponin-Positive Patients with Non-Obstructive Coronary
Fabienne Kreimer1,2, Clara Schlettert3, Mohammad Abumayyaleh4
1Department of Cardiology and Rhythmology, University Hospital St. Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Insights
Coronary sclerosis in patients with non-obstructive coronary arteries is linked to more health issues and higher rates of in-hospital and out-of-hospital events. This highlights the importance of managing cardiovascular risk factors in these individuals.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Coronary sclerosis is a known risk factor for obstructive coronary artery disease (CAD).
- Limited understanding exists regarding the prognostic impact of coronary sclerosis on patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA).
Purpose of the Study:
- To investigate the prognostic influence of coronary sclerosis on in-hospital and out-of-hospital events.
- To analyze outcomes in troponin-positive patients with non-obstructive coronary arteries and varying degrees of coronary sclerosis.
Main Methods:
- Retrospective cohort analysis of prospectively collected data from 373 troponin-positive patients with non-obstructive coronary arteries.
- Coronary angiography data from 2010-2021, with a follow-up period of 6.2 ± 3.1 years.
- Coronary sclerosis defined as plaques without >50% stenotic lesions in major epicardial arteries.
Main Results:
- Patients with coronary sclerosis were older and had a higher prevalence of comorbidities including diabetes, hypertension, COPD, CKD, and atrial fibrillation.
- The incidence of in-hospital events (42.8% vs. 29.9%) and out-of-hospital events (46.0% vs. 26.1%) was significantly higher in the coronary sclerosis group.
- Mortality rates were numerically higher in patients with coronary sclerosis (29.4% vs. 20.0%).
Conclusions:
- Coronary sclerosis in patients with non-obstructive coronary arteries is associated with a greater burden of comorbidities and increased medication use.
- These patients experience significantly higher rates of both in-hospital and out-of-hospital adverse events.
- The increased event rates are primarily attributed to the clustering of cardiovascular risk factors.
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.
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