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KMID : 0880520120480010039
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Chonnam Medical Journal
2012 Volume.48 No. 1 p.39 ~ p.46
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Is Myocardial Infarction in Patients without Significant Stenosis on a Coronary Angiogram as Benign as Believed?
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Rhew Shi-Hyun
Ahn Young-Keun
Kim Min-Chul
Jang Su-Young
Cho Kyung-Hoon
Hwang Seung-Hwan
Lee Min-Goo
Ko Jum-Suk
Park Keun-Ho
Sim Doo-Sun
Yoon Nam-Sik
Yoon Hyun-Ju
Kim Kye-Hun
Hong Young-Joon
Park Hyung-Wook
Kim Ju-Han
Jeong Myung-Ho
Cho Jeong-Gwan
Park Jong-Chun
Kang Jung-Chaee
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Abstract
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The present study aimed to investigate the clinical characteristics and 1-year outcomes of acute myocardial infarction (AMI) patients without significant stenosis on a coronary angiogram comparison with the clinical characteristics and outcomes of patients with significant coronary artery stenosis. A total of 1,220 patients with AMI were retrospectively classified into Group I (≥50% diameter stenosis, n=1,120) and Group II (<50%, n=100). Group II was further divided into two subgroups according to the underlying etiology: cryptogenic (Group II-a, n=54) and those with possible causative factors (Group II-b, n=46). Patients in Group II were younger, were more likely to be women, and were less likely to smoke and to have diabetes mellitus than were patients in Group I. The levels of cardiac enzymes, LDL-cholesterol levels, and the apo-B/A1 ratio were lower in Group II. However, 1-month and 12-month rates of major adverse cardiac events (MACE) were not significantly different between the two groups. The Group II-b subgroup comprised 29 patients with vasospasm, 11 with myocardial bridge, and 6 with spontaneous thrombolysis. Left ventricular ejection fraction and creatinine clearance were lower and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were higher in Group II-a than in Group II-b. However, outcomes including MACE and mortality at 12 months were not significantly different between the two subgroups. The 1-year outcomes of patients in Group II were similar to those of patients in Group I. The clinical outcomes in Group II-a were also similar to those of Group II-b, although the former group showed higher levels of NT-proBNP and hs-CRP.
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KEYWORD
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Coronary angiography, Myocardial infarction, Stenosis
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