Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease

Background-A proportion of patients who present with suspected acute corona ry syndrome (ACS) are found to have insignificant coronary artery disease ( CAD) during coronary angiography, but these patients have not been well cha racterized. Methods and Results-Of the 5767 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) tri al and who underwent in-hospital angiography, 88% had significant CAD (any stenosis >50%), 6% had mild CAD (any stenosis >0% to less than or equal to 50%), and 6% had no CAD (no stenosis identified). The frequency of death or nonfatal myocardial infarction at 30 days was reduced with eptifibatide tr eatment in patients with significant CAD (18.3% Versus 15.6% for placebo, P =0.006) but not in those with mild CAD (6.6% versus 5.4%, P=0.62) and with no CAD (3.0% versus 1.2%, P=0.28), We identified independent baseline predi ctors of insignificant CAD (mild or no CAD) and used them to develop a simp le predictive nomogram of the probability of insignificant CAD for use at h ospital presentation. This nomogram was validated in a separate population of patients with non-ST-segment elevation ACS, Conclusions-Patients with suspected ACS found to have insignificant CAD hav e a low risk of adverse outcomes, do not appear to benefit from treatment w ith eptifibatide, and can be predicted with a simple nomogram drawn from ba seline characteristics. Because patients with significant CAD appear to hav e an enhanced benefit from eptifibatide treatment, the predictive nomogram developed can be used to determine indications for glycoprotein IIb/IIIa bl ockade.