Características clínicas, epidemiología y pronóstico del síndrome coronario agudo sin elevación del segmento ST con coronarias sanas

Abstract

It has been estimated that up to 12% of patients with acute myocardial infarction do not present coronary atherosclerotic disease demonstrable with angiographic studies. We assessed the clinical characteristics and prognosis of acute coronary syndrome without ST-segment elevation with angiographically normal coronary arteries. Comparative retrospective analysis of 58 consecutive patients with this diagnosis and a sample (n = 59) with lesions in angiographic studies, analyzing demographic characteristics, analytical parameters, electrocardiogram, ventricular function and prognosis. The group represented 19% of the totality of acute coronary syndromes, showing a lower prevalence rates of hypercholesterolemia, diabetes mellitus and no record of ischemic heart disease (p = 0.043 to p = 0.005). The presence of regional wall motion abnormalities was significantly higher in the group with angiographic lesions (76.3% vs 41.4%; p < 0.01). In-hospital mortality rate showed a non significant trend toward to be lower in the group with normal angiogram (1.7% vs 8.4%). The absence of significant coronary artery disease in acute coronary syndrome without ST-segment elevation is not infrequent and was related to a lower cardiovascular risk profile and the absence of regional wall motion abnormalities showing a trend toward better in-hospital prognosis.