We retrospectively analyzed all patients with ACS plus ischemic-marker elevation from May 2002 through September 2005. Follow-up was obtained primarily by telephone interviews. Of the 1,437 ACS patients who were screened, 127 (8.8%) had noncritical stenosis (study group), and 509 (35.4%) had sufficient stenosis (>50%) to warrant PCI (control group). Patients with noncritical stenosis (≤50%) were significantly younger, were more frequently women, and had fewer risk factors. Myocardial infarction or PCI/CABG occurred in no patients with noncritical stenosis (follow-up, 12.2 mo) and in 5.1% or 16.1% (respectively) of patients with critical stenosis (follow-up, 11.1 mo; P <0.05 for revascularization). Cardiac death was more likely in patients without critical stenosis, but insignificantly so (2.4% vs 1.8%, P=0.6).
Subanalysis: Of patients without critical stenosis, 52.8% had smooth coronary arteries, and 47.3% had mild-to-moderate atherosclerosis (stenosis ≤50%). Follow-up revealed no deaths in the 1st subgroup and 3 cardiac deaths (5%) in the 2nd (P=0.06).
We conclude that the prognosis of patients without significant stenosis was significantly better in regard to revascularization, but statistically the same in regard to mortality.