Pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa / Long-term prognosis of patients with non—ST-segment elevation acute myocardial infarction and coronary arteries without significant stenosis

Introducción y objetivos: El significado pronóstico de la ausencia de lesiones coronarias significativas en pacientes con infarto agudo de miocardio sin elevación del segmento ST es motivo de controversia. Se investigó en una cohorte contemporánea el pronóstico a largo plazo de esos pacientes. Métodos: Estudio observacional retrospectivo de 5.203 pacientes con síndrome coronario agudo. Mediante propensity score matching, se obtuvieron dos grupos de 367 pacientes con infarto agudo de miocardio sin elevación del segmento ST apareados por la ausencia o presencia de lesiones coronarias significativas. En la cohorte apareada, se determinó el impacto de la ausencia de lesiones coronarias significativas en mortalidad o reingresos por síndrome coronario agudo durante 4,8 ± 2,6 años después del alta. Resultados: La mortalidad o el reingreso por síndrome coronario agudo fueron menos entre los pacientes sin lesiones significativas (el 26,4 frente al 32,7%; p = 0,09). La mortalidad en ambos grupos fue del 19,1%. En cambio, los pacientes sin lesiones significativas presentaron menor incidencia de reingreso por síndrome coronario agudo: 2,0 frente a 3,9/100 personas-año; p = 0,003). La incidencia de muerte o reingreso por síndrome coronario agudo fue similar entre los pacientes sin lesiones y enfermedad significativa de un vaso (el 26,4 frente al 27,5%; p = 0,19), aunque más baja que la observada en pacientes con afección de dos vasos (37,8%; p = 0,007) y tres vasos/tronco común izquierdo (41,1%; p = 0,002). Conclusiones: Los pacientes con infarto agudo de miocardio sin elevación del segmento ST y coronarias sin lesiones presentan similar mortalidad a largo plazo que el grupo con lesiones significativas, pero reingresan menos frecuentemente por síndrome coronario agudo. La mortalidad o reingreso por síndrome coronario agudo de pacientes sin lesiones es similar que con enfermedad de un vaso, pero menor que en la de dos o más vasos (AU)

Introduction and Objectives: There is debate regarding the prognostic significance of the absence of significant coronary lesions in patients with non—ST-segment elevation acute myocardial infarction. We investigated long-term prognosis in a contemporary cohort of these patients. Methods: Retrospective observational study of 5203 patients with acute coronary syndrome. Propensity score matching was used to create 2 groups of 367 patients with non—ST-segment elevation acute myocardial infarction matched by the absence or presence of significant coronary lesions. In the matched cohort, we determined the impact of the absence of significant coronary lesions on mortality or readmission for acute coronary syndrome for 4.8 (2.6) years after discharge. Results: Mortality or readmission for acute coronary syndrome was lower among patients without significant lesions (26.4% vs 32.7%; P = .09). Mortality in both groups was 19.1%. In contrast, patients without significant lesions had a lower incidence of readmission for acute coronary syndrome (2.0/100 vs 3.9/100 person-years; P = .003). The incidence of mortality or readmission for acute coronary syndrome was similar in patients without significant lesions and those with significant 1-vessel disease (26.4% vs 27.5%; P = .19), but lower than that in patients with 2-vessel disease (37.8%; P = .007) and 3-vessel disease or left main coronary artery disease (41.1%; P = .002). Conclusions: Patients with non—ST-segment elevation acute myocardial infarction and coronary arteries without significant lesions have similar long-term mortality but lower readmission rates for acute coronary syndrome than patients with significant lesions. Mortality or readmission for acute coronary syndrome is similar in patients without significant lesions and patients with 1-vessel disease, but lower than in patients with disease in 2 or more vessels (AU)

Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?

OBJECTIVES: The risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke. METHODS: This was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7-7.1 years). RESULTS: 184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%). CONCLUSIONS: The 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.