Acute Coronary Syndrome with Normal or Near-Normal Coronary Angiography:Prevalence and Clinical Outcomes among Yemeni Patients

Abstract Background: Nonobstructive acute coronary syndrome or acute coronary syndrome with normal or near-normal coronary angiography (ACSNONCA) occurs in 10% to 25% of patients undergoing coronary angiography and in up to 6% of patients with troponin-positive ACS. Prevalence of ACSN-NOCA and its clinical outcomes were not discussed in previous studies in Yemen. Aim of Study: Our study aimed to compare demographic and clinical findings and prognosis in patients who have ACS with stenosis <50% (Group I) with patients who have ACS with critical obstructive disease, requiring percutaneous coronary intervention (Group II). Patients and Methods: The total population (n=327) was divided according to the angiographic findings into: Group I (stenosis <50%) with 114 patients (14.8%) and Group II (stenosis >50%) with 213 patients (27.6%). During the period January 2010 through September 2015, patients were admitted at Algamhoria Teaching Hospital, Aden and undergone cardiac catheterization in Cardiac Surgery Center at Althawra Hospital, Sana'a. Results: Group I Patients (stenosis <50%) were signifi-cantly younger were more likely to be female, younger, with fewer risk factors, compared to Group I Patients. We isolated and defined two subgroups within Group I: Group IA: Patients with normal angiograms (n=60, 52.6%) and Group IB patients with stenosis of 20-50% (n=54, 47.4%). Patients with stenosis of 20%-50% were relatively older males, with an increasing frequency of nondiabetic, with a history of chronic heavy chewing and with a worse prognosis, during long-term eval-uation. Follow-up data revealed that myocardial infarction was found in 1.8% of Group IA and in 5.2% of Group IB patients. Follow-up revealed no deaths in Group IA patients and two cardiac deaths (3.7%) in Group IB patients. Conclusions: Prognosis of patients with nonobstructive stenosis was significantly better than that of patients with critical obstructive stenosis. However, patients with stenosis of 20-50% had a worse prognosis than did those with normal coronary arteries.