The Clinical Outcome of Acute Myocardial Infarction with Normal Coronary Angiogram

Kim, Weon; Jeong, Myung Ho; Gill, Gwang Chae; Jeong, Woo Gon; Hong, Young Joon; Lee, Seung Hyun; Park, Ok Young; Park, Woo Seok; Kim, Ju Han; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chae

Abstract

BACKGROUND AND OBJECTIVES
Little data exist concerning the clinical outcome of patients with acute myocardial infarction (AMI) and angiographically normal coronary arteries (NCA). The purpose of this study was to evaluate the clinical outcome, the etiological factors and prognosis of these patients.
SUBJECTS AND METHODS
The subjects were divided into two groups according to findings from coronary angiograms performed between January 1999 and December 2001, Group 1 : comprised of 46 patients, 34 males and 12 females, with a mean age of 50.4+/-11.9 years, had AMI with NCA ; Group II : 181 patients, 143 males and 38 females, with a mean age of 59.0+/-10.3 years, with AMI and total occlusion of the coronary arteries.
RESULTS
The percentages of smoking and hypertension were similar between the two groups ; a higher prevalence rates of hyperlipidemia and diabetes were observed in group II compared to group I (p=0.03, 0.01). In group I, coronary spasm, combined inflammatory diseases and embolization were demonstrated in 32.6, 6.5 and 4.3% of subjects, respectively. The left ventricular ejection fraction was higher in group I than group II (51.5+/-11.3% vs. 46.2+/-10.5%, p=0.006). In-hospital outcomes, with the combined end-point defined as death, re-infarction and stroke was 0% in group I vs. 7.7% in group II (p=0.07). The mean long-term survival rate during the 26.5-month clinical follow-up were 100 and 92.2% in groups I and II (p=0.04), respectively.
CONCLUSION
A coronary spasm is the most common cause of AMI with NCA, but these patients had the higher long-term clinical event-free survival.