Frequency of Non-Obstructive Coronary Artery Disease in Patients with Non-ST-Segment Myocardial Infarction Taken for Early Invasive Angiography
DOI:
https://doi.org/10.70749/ijbr.v3i7.1904Keywords:
Non-obstructive CAD, NSTEMI, Early angiography, Coronary artery diseaseAbstract
Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is a common presentation of acute coronary syndrome, typically managed with early invasive coronary angiography. Objective: To determine the frequency of non-obstructive coronary artery disease in patients with non-ST-segment elevation myocardial infarction undergoing early invasive coronary angiography. Methods: This cross-sectional study was conducted at the Department of Cardiology, NICVD, Karachi, from 14 March 2025 to 14 June 2025. A total of 156 patients aged 40–80 years, diagnosed with NSTEMI, and undergoing early coronary angiography were enrolled through non-probability consecutive sampling. Patients with prior coronary intervention or vasoactive medication use were excluded. Results: Among 156 patients, the mean age was 61.2 ± 9.4 years, and 66.7% were male. Non-obstructive coronary artery disease was observed in 29.5% of patients. NO-CAD was significantly more frequent in females (42.3% vs. 23.1%; p = 0.012). No significant associations were found between NO-CAD and age, BMI, diabetes mellitus, or hypertension. Typical chest pain was more prevalent in patients with obstructive CAD (p = 0.041), while smoking history was also significantly associated with obstructive CAD (p = 0.025). Conclusion: Non-obstructive coronary artery disease is a common finding in NSTEMI patients undergoing early invasive angiography, particularly among females. These results emphasize the need for individualized patient assessment to avoid unnecessary interventions and optimize management strategies. Further large-scale studies are recommended to confirm these findings.
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1. Gue YX, Kanji R, Gati S, Gorog DA. MI with Non-obstructive Coronary Artery Presenting with STEMI: A Review of Incidence, Aetiology, Assessment and Treatment. Eur Cardiol. 2020;15:e20.
https://doi.org/10.15420/ecr.2019.13
2. Jeżynkowska M, Siudak Z, Malinowski KP, Zandecki Ł, Zabojcsek M, Kameruca T, et al. ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry. PLoS One. 2021;16(8):e0254427.
https://doi.org/10.1371/journal.pone.0254427
3. Deso D, Rahimi F, Aman M, Nührenberg TG, Löffelhardt N, Schmitz R, et al. Prevalence and Causes of Myocardial Infarction with Non-Obstructive Coronary Arteries in a Contemporary Cohort of Patients with Suspected Myocardial Infarction. J Clin Med. 2021;10(2):5188.
https://doi.org/10.3390/jcm10215188
4. Jeżynkowska M, Januszek R, Piers K, Surdacki A, Bartuś S, Dudek D. Impact of sex on the follow-up course and predictors of clinical outcomes in patients hospitalised due to myocardial infarction with non-obstructive coronary artery: a single-centre experience. Kardiol Pol. 2019;77:198–206.
https://doi.org/10.5603/kp.a2018.0245
5. Pasupathy S, Air T, Dreyer R, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–70.
https://doi.org/10.1161/circulationaha.114.011201
6. Jeżynkowska M, Januszek R, Wanha W, Malinowski KP, Kunik P, Trzaska J, et al. Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries. Medicina (Kaunas). 2020;56:432–9.
https://doi.org/10.3390/medicina56090432
7. Ballesteros-Ortega D, Martínez-González O, Gómez-Casero RB, Quintana-Díaz M, de Miguel-Balsa E, Martín-Parra C, et al. Characteristics of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) from the ARIAM-SEMICUVI registry: development of a score for predicting MINOCA. Vasc Health Risk Manag. 2019;15:57–67.
https://doi.org/10.2147/vhrm.s185082
8. Safdar S, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, et al. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc. 2018;7:e009174.
https://doi.org/10.1161/jaha.118.009174
9. Fazal A, Siddiqui FA, Afzal MH, Masood U, Shahzad K, Rahman A. Frequency of non-obstructive coronary artery disease in patients admitted for elective coronary angiography. Pak J Med Health Sci. 2022;16(6):53–6.
https://doi.org/10.53350/pjmhs22166295
10. Javed HMIR, Tariq A, Adam MA, Bhatt TA, Ahmed W, Sharif A. Determining the Frequency of Non-Obstructive Coronary Artery Disease in Elective Angiography Cases: Prevalence of Non-Obstructive Coronary Artery Disease. Therapisti J Therap Amp Rehab Sci. 2024;5(01):2-6.
https://doi.org/10.54393/tt.v5i01.202
11. Adnan Fazal, Fawad Ali Siddiqui, Muhammad Haroon Afzal, Usama Masood, Kashif Shahzad, Abdul Rahman. (2022). Frequency of Nonobstructive Coronary Artery Disease in patients admitted for Elective Coronary Angiography. Pakistan Journal of Medical & Health Sciences, 16(06), 295.
https://doi.org/10.53350/pjmhs22166295
12. Ikramullah, Ahmad F, Haq A, Khan SW. Angiographic findings in patients with Non-ST-elevation myocardial infarction. Pak J Med Sci. 2024 Nov;40(10):2228-2232. PMID: 39554664; PMCID: PMC11568709.
https://doi.org/10.12669/pjms.40.10.9499.
13. Abdelmonem YY, Bakr AA, El-Hossary HG, Ghany MMA. Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease. Egypt Heart J. 2017 Sep;69(3):191-199. Epub 2017 May 8. PMID: 29622976; PMCID: PMC5883485.
https://doi.org/10.1016/j.ehj.2017.03.001.
14. Steiro OT, Aakre KM, Tjora HL, Bjoerneklett RO, Skadberg OS, Bonarjee VV, et al. Chest pain characteristics and their ability to predict NSTEMI according to gender and age in patients presenting with suspected ACS. European Heart Journal. 2021 Oct; 42(Supplement_1): 724-1477.
https://doi.org/10.1093/ eurheartj/ehab724.1477.
15. Ängerud KH, Sederholm Lawesson S, Isaksson RM, Thylén I, Swahn E. Differences in symptoms, rst medical contact and pre-hospital delay times between patients with ST-and non-ST-elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care. 2019 Apr; 8(3): 201-7.
https://doi.org/10.1177/2048872617741734.
16. Oz TK, Özbilgin N, Sungur A, Bas EG, Zengin A, Gürol T, et al. Prevalence of metabolic syndrome in young patients with ST-elevation myocardial infarction. International Journal of the Cardiovascular Academy. 2018 Jul; 4(3): 53.
https://doi.org/10.4103/ CA. CA_10_18.
17. Wu CC, Hsu WD, Islam MM, Poly TN, Yang HC, Nguyen PA, et al. An arti cial intelligence approach to early predict non-ST-elevation myocardial infarction patients with chest pain. Computer Methods and Programs in Biomedicine. 2019 May; 173: 109-17.
https://doi.org/10.1016/j.cmpb.2019.01.013.
18. Ahmed R, Kamran Islam M, Ashraf N, Mateen Anwer M, Ali M, Iqbal R. Frequency Of Triple Vessel Coronary Artery Disease In Patients Admitted With Non-St-Elevation Myocardial Infarction Undergoing Coronary Angiography For First Tim. Pak Armed Forces Med J [Internet]. 2025 Feb. 28 [cited 2025 Jul. 12];75(1):182-7.
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