(Circulation. 2000;102:1101.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Clinical and Therapeutic Profile of Patients Presenting With Acute Coronary Syndromes Who Do Not Have Significant Coronary Artery Disease
From the Duke Clinical Research Institute (M.T.R., R.A.H., K.S.P., E.M.O., R.M.C.), Durham, NC; the Cleveland Clinic Foundation (D.M.P., D.L.B, A.M.L., E.J.T), Cleveland, OH; the Thoraxcenter (M.L.S., M.A.), Erasmus University, Rotterdam, the Netherlands; COR Therapeutics, Inc (M.M.K.), South San Francisco, Calif; Hospital Tenon (A.V.), Paris, France; the National Institute of Cardiology (W.R.), Warsaw, Poland; and Eberhard Karls University (K.K.), Tubingen, Germany.
Correspondence to Matthew T. Roe, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail roe00001{at}mc.duke.edu
Background—A proportion of patients who present with suspected acute coronary syndrome (ACS) are found to have insignificant coronary artery disease (CAD) during coronary angiography, but these patients have not been well characterized.
Methods and Results—Of the 5767 patients with non–ST-segment
elevation ACS who were enrolled in the Platelet
Glycoprotein IIb/IIIa in Unstable Angina: Receptor
Suppression Using Integrilin (Eptifibatide) Therapy (PURSUIT) trial and
who underwent in-hospital angiography, 88% had significant CAD (any
stenosis >50%), 6% had mild CAD (any stenosis >0%
to 
50%), and 6% had no CAD (no stenosis identified). The
frequency of death or nonfatal myocardial infarction at 30 days was
reduced with eptifibatide treatment in patients with significant CAD
(18.3% versus 15.6% for placebo, P=0.006) but not in
those with mild CAD (6.6% versus 5.4%, P=0.62) and
with no CAD (3.0% versus 1.2%, P=0.28). We identified
independent baseline predictors of insignificant CAD (mild or no CAD)
and used them to develop a simple predictive nomogram of the
probability of insignificant CAD for use at hospital
presentation. This nomogram was validated in a separate
population of patients with non–ST-segment elevation ACS.
Conclusions—Patients with suspected ACS found to have insignificant CAD have a low risk of adverse outcomes, do not appear to benefit from treatment with eptifibatide, and can be predicted with a simple nomogram drawn from baseline characteristics. Because patients with significant CAD appear to have an enhanced benefit from eptifibatide treatment, the predictive nomogram developed can be used to determine indications for glycoprotein IIb/IIIa blockade.
Key Words: coronary disease • platelets • prognosis • angiography • ischemia
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