Acute coronary syndrome with coronary arteries without obstructive lesions

Diagnostic therapeutic controversy?

Abstract

Acute coronary syndrome (ACS) without obstructive angiographic lesions has a prevalence of 10 to 15%. Different pathophysiologic mechanisms have been proposed. There is a paucity of data in our country regarding this entity. Aim: To determine the prevalence, clinical characteristics, and assess major outcomes of ACS with angiographically normal coronary arteries, in a cardiovascular reference center within a period of two years. Methods: Retrospective case-control study of patients with ACS that were submitted to coronary angiography and divided into patients with coronary artery disease (CAD, n=44) and those without obstructive coronary lesions (NCAD, n=20). Statistical analysis was performed establishing a p <0.05 as significant, X2 was used for categorical and student t test for continuous variables. Results: From a total of 64 patients, 31% had NCAD, in this group 80% were females and had higher prevalence of family history of early coronary artery disease, NCAD vs CAD: 20% vs 2.2% (p=0.01). There was no significant difference in individual cardiovascular outcomes between groups in 2 years. In 70% of cases the pathophysiological mechanism was not assessed, not detecting the basic etiology. Conclusions: Prevalence of ACS without obstructive angiographic lesions represents a significant proportion of patients, with predominance of female gender and family history of early coronary artery disease with no significant difference of individual cardiovascular outcomes between groups.