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