Comparison of prognosis between patients with acute coronary syndrome and non obstructive coronary artery disease with those with significant coronary artery disease: a cohort study

Abstract

Introduction: The universal definition of myocardial infarction (MI) indicates that MI is diagnosed when there is a rise and fall of cardiac biomarkers such as troponin in combination with ischemic symptoms, ischemic ECG changes, imaging evidence of loss of viable myocardium, or identification of an intracoronary thrombus. Coronary obstruction is not required according to this definition. Angiography in patients with myocardial infarction most commonly reveals one or more significantly narrowed coronary arteries, but a substantial minority of patients with spontaneous MI have no obstructive coronary artery disease (NOCAD) at angiography. In the last years several studies have been done to determine if, as it is said in clinical practice, these patients have a favourable prognosis in comparison with significant occluded coronary arteries. Objective: The goal of this study is to determine the long-term prognosis of patients who suffer from a myocardial infarction and do not have significant obstructive coronary artery disease in comparison with patients who undergo myocardial infarction and have obstructive coronary artery disease, in Catalonia, using ultrasensitive troponins for the diagnostic. Design: A Multi-centric study in the cardiology department of Hospital Universitari Doctor Josep Trueta (Girona), Hospital Sant Joan de Deu (Barcelona), Hospital Germans Trias i Pujol de Badalona (Badalona), Hospital del Mar (Barcelona). Methods: 1328 patients undergoing ACS will be submitted to a coronary angiography. In those with no culprit lesion in coronary arteries, intracoronary optical coherence tomography (OCT) will be performed in order to determine the aetiological mechanism of myocardial infarction, apply a suitable treatment and to evaluate the prognosis at one year. This prospective cohorts study will be realised in 3 years at the area of Catalonia (Spain)