Abstract

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=＜0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.