A 50-year-old white female nonsmoker without history of cardiovascular disease (CVD) and treated only with ramipril for hypertension was hospitalized for UA. The ECG revealed T inversion in the lateral leads. The medical student who admitted the patient asks you what is the proportion of patients that undergo coronary angiography for ACS who have nonsignificant CAD.
A. <5%20% to 30%. A proportion of patients who present with suspected ACS are found to have insignificant CAD during coronary angiography. Of the 5,767 patients with non-ST-segment-elevation ACS who were enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin (Eptifibatide) Therapy (PURSUIT) trial and who underwent inhospital angiography, 88% had significant CAD (any stenosis >50%), 6% had mild CAD (any stenosis >0% to ≤50%), and 6% had no CAD (no stenosis identified). Overall, 12% of the patients had nonsignificant CAD. Patients with nonsignificant CAD were more likely to be women, nonwhite, younger, nondiabetic, nonhypercholesterolemic, without history of CVD, without ST-segment changes, but with more T-wave inversion compared with patients with significant CAD. Based on the profile of the patient admitted, her probability of having nonsignificant CAD is >12%.