Emergence of Nonobstructive Coronary Artery Disease
A Woman’s Problem and Need for Change in Definition on Angiography
Carl J. Pepine, Keith C. Ferdinand, Leslee J. Shaw, Kelly Ann Light-McGroary, Rashmee U. Shah, Martha Gulati, Claire Duvernoy, Mary Norine Walsh, C. Noel Bairey Merz and ACC CVD in Women Committee
Tabulation of Findings in NSTE ACS Patients With Nonobstructive CAD
• Overall, ∼10% of NSTE ACS patients have nonobstructive CAD.
• Sex differences in patient characteristics and outcomes are similar to those with obstructive CAD.
○ Women are twice as likely to have nonobstructive CAD than men.
○ Those with nonobstructive CAD have lower event rates than patients with obstructive CAD.
○ Women are less likely to undergo early angiography and to receive guideline-recommended therapies, suggesting opportunities for improved management.
• Death or MI occurs in ∼2% of these patients by 30 days.
• Although death/MI rates are low, they are not negligible. Furthermore, patients such as those selected for analyses (e.g., reaching hospital alive and undergoing early angiography and/or consenting to a randomized trial) are recognized to have lower events rates than those in the all-inclusive ACS population.
• The presence of nonobstructive CAD alone does not justify dismissing opportunities for secondary prevention.