Predictors and outcome of acute coronary syndrome in patients with insignificant coronary artery disease / Adel Abdelgawad Abdelazim Bakr ; Supervised Mohammed Mahmoud Abdelghany , Hossam Eldin Ghanem Elhossary , Yasser Yazeed Abdelmonem

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiology

Methods: This prospective observational study included 200 consecutive patients admitted with the diagnosis of ACS to coronary care unit, cardiology department over a period from June 2013 to May 2014. All patients underwent cardiac catheterization and classified into two groups, group I (insignificant CAD (lumen diameter <50%)) and group II (significant CAD (one or more vessels >70% diameter stenosis)).Results: Patients with insignificant CAD were significantly younger (p<0.001), more likely to be female (p=0.006), more often non-white (p=0.032), less likely to smoke (p=0.006), less likely to have diabetes mellitus (p<0.001), and less likely to have history of CAD (p=0.042 ) or PCI (p=0.037), with similar prevalence of other traditional significant CAD risk factors (hypertension, dyslipidemia, and premature family history of significant CAD). These patients were less likely to have ischemic ST-segment changes on presentation (p<0.001), less likely to present with typical chest pain (p<0.001), had lower elevations in peak troponin I (p <0.001) and CK-MB levels (p <0.001), with lower LDL-C (p = 0.006), and higher HDL-C levels (p=0.020). Patients with insignificant CAD were significantly less likely to be treated in-hospital with thienopyridines (p<0.001), lipid-lowering agents (p<0.001), b-blockers (p=0.002), ACE inhibitor/ARBs (p=0.007), and higher rates of calcium channel blocker therapy (p<0.001). This trend continued at discharge. Also aspirin was significantly more prescribed at discharge in the significant versus insignificant group (98.0% vs 81.0%, p <0.001)

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