040 Non ST-elevation myocardial infarction with a normal coronary angiogram in women: is it serious?

Abstract

The incidence and long term prognosis of women presenting troponin positive NSTE-ACS and a normal angiogram is unknown. To investigate the incidence, characteristics and long term prognosis of women presenting with a NSTEMI and normal coronary angiogram compared to women with NSTEMI and significant coronary artery disease (CAD) on the angiogram. Between 1999 and 2008, we screened patients presenting with an acute coronary syndrome (ACS) to identify those with a positive troponin and a normal angiogram. Extra-cardiac causes of troponin elevation were excluded. Women were matched by age and presence or absence of ST-elevation with a 1:2 ratio, to women with significant CAD. We compared characteristics and outcomes of the two groups of women. Over 4085 ACS patients, 1581 had a significant elevation of troponin, with 343 women (21.7%) and 1238 men (78.3%). One hundred and twelve patients (7.1%) had a normal angiogram with a 3-fold higher proportion of women (14.5%; n = 50) compared to men (5.0%, n = 52); p<0.001. When these women with a normal angiogram were compared with 100 women with significant CAD, they were less likely to have a high peak of troponin (> 5 times the upper limit of normal: 46% vs. 80%, p<0.0001). No other significant difference was found between the two groups. Mean follow-up was 4.3 +/− 3.1 years. Women with a normal angiogram had an excellent survival rate of 91.3% compared to 71.2% in women with CAD (p = 0.03), they had also a lower readmission rate for cardiovascular reason, (14% vs. 54%, p = 0.01). Women presenting with NSTEMI who have a normal angiogram, do not differ from women with NSTEMI and angiographic CAD. However, they have a smaller rise of troponin and a much better long-term prognosis.