Clinical InvestigationAcute Ischemic Heart DiseasePrevalence, predictors, and outcomes of patients with non–ST-segment elevation myocardial infarction and insignificant coronary artery disease: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative
Section snippets
CRUSADE initiative
The CRUSADE quality improvement initiative is a nationwide program involving 465 hospitals in the United States. Data were collected on consecutive patients meeting the inclusion criteria only during the initial hospitalization in an anonymous fashion, and the institutional review board of each institution approved participation in this initiative. Data collected included baseline characteristics, use of short-term medications within 24 hours of presentation, use and timing of invasive cardiac
Prevalence and baseline characteristics
Of 88 097 patients included in the CRUSADE database from 2001 to 2003, 38 301 (43.4%) patients without a prior history of CABG were diagnosed with NSTEMI and underwent angiography. Of these 38 301 patients, 3306 patients (8.6%) were identified as having insignificant CAD, whereas 34 995 patients (91.4%) were found to have CAD. Patients without significant CAD were younger (median age 59 vs 64 years, P < .0001), more likely to be female (57% vs 35%, P < .0001), more often black (19% vs 10%, P <
Discussion
We undertook an analysis of the prevalence, predictors, and outcomes of patients with NSTEMI and insignificant CAD on angiography. Previous studies in patients with ACS and insignificant CAD were from clinical trial populations or consecutive angiography registries, but were not limited solely to patients with serum evidence of myocardial necrosis.5, 8, 9, 10 The CRUSADE initiative provides a large national sample of patients with high-risk NSTE ACS presenting to >400 US hospitals. From the
References (24)
- et al.
Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome
J Am Coll Cardiol
(2000) - et al.
Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound
J Am Coll Cardiol
(2002) - et al.
ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)
J Am Coll Cardiol
(2000) - et al.
Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries
Am J Cardiol
(1986) - et al.
Presentation and late outcome of myocardial infarction in the absence of angiographically significant coronary artery disease
Am J Cardiol
(1988) - et al.
Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial)
Am J Cardiol
(1994) - et al.
Impact of the troponin standard on the prevalence of acute myocardial infarction
Am Heart J
(2003) Things ain't what they used to be: impact of a new definition of myocardial infarction
Am Heart J
(2002)Troponin measurements in ischemic heart disease: more than just a black and white picture
J Am Coll Cardiol
(2001)- et al.
Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients
J Am Coll Cardiol
(2004)
Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease
Am Heart J
Ergonovine maleate testing during cardiac catheterization: a 10-year perspective in 3,447 patients without significant coronary artery disease or Prinzmetal's variant angina
J Am Coll Cardiol
Cited by (0)
CRUSADE is a national quality improvement initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation, Kenilworth, NJ. Bristol-Myers Squibb, New York, NY/Sanofi-Aventis Pharmaceuticals, Paris, France. Partnership provides additional funding support. Millennium Pharmaceuticals, Inc., Cambridge, MA, also funded this work.