Characteristics and management of patients with acute coronary syndrome and normal or non-significant coronary artery disease: Results from acute Coronary Syndrome Israeli Survey (ACSIS) 2004-2010

BACKGROUND: An important subset of patients presenting with acute coronary syndrome (ACS) are found to have either normal coronaries (NCs) or non-obstructive coronary artery disease (NOCAD; lumen diameter narrowing <50%). OBJECTIVES: To explore the characteristics and management strategies in this population in a real-world setting. METHODS: The Acute Coronary Syndrome Israeli Survey (ACSIS) database was utilized to compare the characteristics and therapeutic approach for patients who underwent angiography for ACS and had either NC (n ≤ 84; 2%), NOCAD (n ≤ 79; 2%), or obstructive coronary artery disease (OCAD; n ≤ 3523; 96%). RESULTS: Baseline characteristics were comparable, save for a younger age and a higher proportion of females in the NC group (P<.001 for both). Prior to admission, chronic anticoagulant therapy was more frequently used in the NC vs the OCAD group (4.8% vs 1.6%, respectively; P≤.02). Recommended ACS evidence-based medications, both in-hospital and at discharge, were less frequently prescribed to patients with NC or NOCAD. CONCLUSIONS: In a real-world practice of ACS, underutilization of evidence-based medications in patients with NC or NOCAD was observed. Nonetheless, its prognostic significance is still unknown and must be explored in larger patient cohorts.