Sex and Race Are Associated With the Absence of Epicardial Coronary Artery Obstructive Disease at Angiography in Patients With Acute Coronary Syndromes

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2010-08, Vol.33 (8), p.495-501
• Main Authors: Chokshi, Neel P., Iqbal, Sohah N., Berger, Rachel L., Hochman, Judith S., Feit, Frederick, Slater, James N., Pena‐Sing, Ivan, Yatskar, Leonid, Keller, Norma M., Babaev, Anvar, Attubato, Michael J., Reynolds, Harmony R.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - ethnology; African Americans - statistics & numerical data; Aged; Asian Americans - statistics & numerical data; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Chi-Square Distribution; Clinical Investigation; Clinical Investigations; Coronary Angiography; Coronary heart disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - ethnology; Ethnic Groups - statistics & numerical data; European Continental Ancestry Group - statistics & numerical data; Female; Heart; Hispanic Americans - statistics & numerical data; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - ethnology; Myocarditis. Cardiomyopathies; New York City; Prevalence; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.20794

Background A substantial minority of patients with acute coronary syndromes (ACS) do not have a diameter stenosis of any major epicardial coronary artery on angiography (“no obstruction at angiography”) of ≥ 50%. We examined the frequency of this finding and its relationship to race and sex. Hypothesis Among patients with myocardial infarction, younger age, female sex and non‐white race are associated with the absence of obstructive coronary artery disease at angiography. Methods We reviewed the results of all angiograms performed from May 19, 2006 to September 29, 2006 at 1 private (n = 793) and 1 public (n = 578) urban academic medical center. Charts were reviewed for indication and results of angiography, and for demographics. Results The cohort included 518 patients with ACS. There was no obstruction at angiography in 106 patients (21%), including 48 (18%) of 258 patients with myocardial infarction. Women were more likely to have no obstruction at angiography than men, both in the overall cohort (55/170 women [32%] vs 51/348 men [15%], P < 0.001) and in the subset with MI (29/90 women [32%] vs 19/168 men [11%], P < 0.001). Black patients were more likely to have no obstruction at angiography relative to any other subgroup (24/66 [36%] vs 41/229 [18%] Whites, 31/150 [21%] Hispanics, and 5/58 [9%] Asians, P = 0.001). Among women, Black patients more frequently had no obstruction at angiography compared with other ethnic groups (16/27 [59%] vs 17/59 [29%] Whites, 17/60 [28%] Hispanics, and 3/19 [6%] Asians, P = 0.001). Conclusions A high proportion of a multiethnic sample of patients with ACS were found to have no stenosis ≥ 50% in diameter at coronary angiography. This was particularly common among women and Black patients. Copyright © 2010 Wiley Periodicals, Inc. This work was supported by the Doris Duke Charitable Foundation. Dr Reynolds is a recipient of the Doris Duke Charitable Foundation Clinical Scientist Development Award. The authors have no other funding, financial relationships, or conflicts of interest to disclose.