Evidence map›Paper›PMID 24847016›Full record

ArticleCirculation. Cardiovascular interventions2014

Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: propensity-matched analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial.

David Planer, Roxana Mehran, E Magnus Ohman, Harvey D White, Jonathan D Newman, Ke Xu, Gregg W Stone

2 registry-linked trialsOpen access · bronzeAbstract readComparative Study
PubMed Publisher
In one paragraph

Article in Circulation. Cardiovascular interventions, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 80 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
80citing papers in PubMed, 3 pooled it
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05122780 phase4unknown statusstarted 2021, after this paper: background citation

PROgnostic Value of Precision Medicine in Patients With Myocardial Infarction and Non-obStructive Coronary artEries: the PROMISE Trial.

Ran2021Enrolled120Registered outcomes17Posted comparisons0ConditionsMyocardial Infarction With Non-Obstructive Coronary ArteriesArmsACEi/ARB, Acetylcholine provocative test, Anticoagulant, Antiplatelet Drug, Beta Blocker
PMID 30913893PMID 25587100PMID 26576922PMID 28179398PMID 25526726PMID 28239487PMID 24071763PMID 24046434PMID 1825037PMID 28476516PMID 28624816PMID 29228159other papers from this trial
Open the trial in the graph
NCT00093158 phase3completednot on this map

The ACUITY Trial: A Randomized Comparison of Angiomax (Bivalirudin) Versus Heparin (Unfractionated Heparin or Enoxaparin) in Patients Undergoing Early Invasive Management for Acute Coronary Syndromes Without ST-Segment Elevation

TypeinterventionalSponsorThe Medicines CompanyRan2003 to 2007Enrolled13,800ConditionsUnstable Angina, Myocardial Infarction, Acute DiseaseArmsAngiomax (bivalirudin) anticoagulant
3 · Its place in the literature

Who cites it

80 citing papers in PubMed, 3 syntheses or guidelines pooled it, 188 citations in OpenAlex.

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  12. Antithrombotic Therapy for Acute Coronary Syndrome.Journal of neuroendovascular therapy · 2025
    Review
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  15. Myocardial Infarction with Nonobstructive Coronary Artery Disease-Definition, Etiopathogenesis, Diagnosis, and Management.The International journal of angiology : official publication of the International College of Angiology, Inc · 2024
    Review
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20 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

David PlanerFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
Roxana MehranFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
E Magnus OhmanFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
Harvey D WhiteFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
Jonathan D NewmanFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
Ke XuFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.).
Gregg W StoneFrom the Hadassah-Hebrew University Medical Center, Jerusalem, Israel (D.P.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); Cardiovascular Research Foundation, New York, NY (R.M., K.X., G.W.S.); Duke University Medical Center, Durham, NC (E.M.O.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); and Columbia University Medical Center, New York, NY (J.D.N., G.W.S.). gs2184@columbia.edu.
Duke University Hospital · USDuke Medical Center · USAuckland City Hospital · NZIcahn School of Medicine at Mount Sinai · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTroponin elevation is a risk factor for mortality in patients with non-ST-segment-elevation acute coronary syndromes. However, the prognosis of patients with troponin elevation and nonobstructive coronary artery disease (CAD) is unknown. Our objective was therefore to evaluate the impact of nonobstructive CAD in patients with non-ST-segment-elevation acute coronary syndromes and troponin elevation enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. METHODS AND

resultsIn the ACUITY trial, 3-vessel quantitative coronary angiography was performed in a formal substudy of 6921 patients presenting with non-ST-segment-elevation acute coronary syndromes. Patients with elevated admission troponin levels were stratified by the presence or absence of obstructive CAD (any lesion with quantitative diameter stenosis >50%). Propensity score matching was performed to adjust for baseline characteristics. Of 2442 patients with elevated troponin, 197 (8.8%) had nonobstructive CAD. Maximum diameter stenosis was 87.4 (73.2, 100.0) versus 22.6 (19.2, 25.7; P<0.0001) in patients with versus without obstructive CAD, respectively. Propensity matching yielded 117 patients with nonobstructive CAD and 331 patients with obstructive CAD, with no significant baseline differences between groups. In the matched cohort, overall 1-year mortality was significantly higher in patients with nonobstructive CAD (5.2% versus 1.6%; hazard ratio [95% confidence interval]=3.44 [1.05, 11.28]; P=0.04), driven by greater noncardiac mortality. Conversely, recurrent myocardial infarction and unplanned revascularization rates were significantly higher in patients with obstructive CAD.

conclusionsPatients with non-ST-segment-elevation acute coronary syndromes and elevated troponin levels but without obstructive CAD, while having low rates of subsequent myocardial infarction and unplanned revascularization, are still at considerable risk for 1-year mortality from noncardiac causes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.

Indexed as

Cardiac CatheterizationElectrocardiographyTriageAcute Coronary SyndromeAgedBiomarkersCoronary AngiographyCoronary Artery DiseaseFemaleHumansMaleMiddle AgedMyocardial InfarctionPrognosisProspective StudiesRetrospective StudiesBiomarkersTroponinacute coronary syndromeprognosispropensity scoretroponin

Identifiers

PMID24847016
OpenAlexW2887391121

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.