Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

Hedvig Bille Andersson; Frants Pedersen; Thomas Engstrøm; Steffen Helqvist; Morten Kvistholm Jensen; Erik Jørgensen; Henning Kelbæk; Sune Bernd Emil Werner Räder; Kari Saunamäki; Eric Bates; Peer Grande; Lene Holmvang; Peter Clemmensen

doi:10.1093/eurheartj/ehx491

Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

Hedvig Bille Andersson, Frants Pedersen, Thomas Engstrøm, Steffen Helqvist, Morten Kvistholm Jensen, Erik Jørgensen, Henning Kelbæk, Sune Bernd Emil Werner Räder, Kari Saunamäki, Eric Bates, Peer Grande, Lene Holmvang, Peter Clemmensen

Institut for Klinisk Medicin

32 Citationer (Scopus)

Abstract

We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with nonobstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population. Conclusions STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	39
Udgave nummer	2
Sider (fra-til)	102–110
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehx491
Status	Udgivet - 7 jan. 2018

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10.1093/eurheartj/ehx491

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Citationsformater

Andersson, H. B., Pedersen, F., Engstrøm, T., Helqvist, S., Jensen, M. K., Jørgensen, E., Kelbæk, H., Räder, S. B. E. W., Saunamäki, K., Bates, E., Grande, P., Holmvang, L., & Clemmensen, P. (2018). Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease. European Heart Journal, 39(2), 102–110. https://doi.org/10.1093/eurheartj/ehx491

Andersson, HB, Pedersen, F, Engstrøm, T, Helqvist, S, Jensen, MK, Jørgensen, E, Kelbæk, H, Räder, SBEW, Saunamäki, K, Bates, E, Grande, P, Holmvang, L & Clemmensen, P 2018, 'Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease', European Heart Journal, bind 39, nr. 2, s. 102–110. https://doi.org/10.1093/eurheartj/ehx491

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title = "Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease",

abstract = "We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with nonobstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population. Conclusions STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.",

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author = "Andersson, {Hedvig Bille} and Frants Pedersen and Thomas Engstr{\o}m and Steffen Helqvist and Jensen, {Morten Kvistholm} and Erik J{\o}rgensen and Henning Kelb{\ae}k and R{\"a}der, {Sune Bernd Emil Werner} and Kari Saunam{\"a}ki and Eric Bates and Peer Grande and Lene Holmvang and Peter Clemmensen",

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doi = "10.1093/eurheartj/ehx491",

language = "English",

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pages = "102–110",

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TY - JOUR

T1 - Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

AU - Andersson, Hedvig Bille

AU - Pedersen, Frants

AU - Engstrøm, Thomas

AU - Helqvist, Steffen

AU - Jensen, Morten Kvistholm

AU - Jørgensen, Erik

AU - Kelbæk, Henning

AU - Räder, Sune Bernd Emil Werner

AU - Saunamäki, Kari

AU - Bates, Eric

AU - Grande, Peer

AU - Holmvang, Lene

AU - Clemmensen, Peter

PY - 2018/1/7

Y1 - 2018/1/7

N2 - We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with nonobstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population. Conclusions STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.

AB - We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with nonobstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population. Conclusions STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.

KW - Journal Article

U2 - 10.1093/eurheartj/ehx491

DO - 10.1093/eurheartj/ehx491

M3 - Journal article

C2 - 29029035

SN - 0195-668X

VL - 39

SP - 102

EP - 110

JO - European Heart Journal

JF - European Heart Journal

IS - 2

ER -

Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

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