Key result
Non-obstructive coronary arteries in patients undergoing emergent angiography for suspected STEMI were associated with higher 1-year mortality than obstructive disease (15.8% vs 6.1%; p<0.001).
Why the study?
Data on the prevalence, etiology, and outcomes of patients presenting with non-obstructive coronary arteries during emergent coronary angiography for suspected STEMI remain limited in contemporary practice.
Does the presence of non-obstructive coronary arteries compared to obstructive coronary arteries affect 1-year mortality in patients undergoing emergent coronary angiography for suspected STEMI?
Cohort (n=405)
No
Does the presence of non-obstructive coronary arteries compared to obstructive coronary arteries affect 1-year mortality in patients undergoing emergent coronary angiography for suspected STEMI?
Patients presenting with suspected STEMI who are found to have non-obstructive coronary arteries have unexpectedly higher 1-year mortality than those with obstructive disease, highlighting a high-risk, heterogeneous population.
Answers are grounded in this paper and cite their sources.
Non-obstructive coronaries warrant clinical vigilance due to excess mortality; extends MINOCA epidemiology in contemporary RCT cohorts.
Background A proportion of patients undergoing emergent coronary angiography for suspected ST-segment elevation myocardial infarction (STEMI) present with non-obstructive coronary arteries ("white caths"). Data on their prevalence, etiology, and outcomes in contemporary practice remain limited. Purpose To describe the prevalence, clinical characteristics, final diagnoses, and 1-year outcomes of patients with non-obstructive coronary arteries following emergent coronary angiography for suspected STEMI. Methods We retrospectively analyzed 405 consecutive patients who underwent emergent coronary angiography for suspected STEMI at our center. Patients were classified as having obstructive (≥50% stenosis) or non-obstructive coronary arteries. Demographics, final diagnosis, and 1-year mortality were compared using Mann–Whitney U and chi-square tests, as appropriate. Results Among 405 patients, 38 (9.4%) had non-obstructive coronary arteries. There were no significant differences in female prevalence (36.6% vs. 27.0%; p = 0.203) or age (median 62 vs. 64 years; p = 0.109). Final diagnoses among "white cath" patients included vasospasm (18.4%), MINOCA (13.2%), acute myocarditis (13.2%), non-cardiac chest pain (10.5%), acute pericarditis (7.8%), early repolarization (7.8%), Takotsubo syndrome (7.8%), aortic valvulopathy (5.0%), dilated cardiomyopathy (5.0%), acute aortic syndrome (5.0%), hypertrophic cardiomyopathy (2.6%), left bundle branch block (2.6%), and other causes. One-year mortality was significantly higher in the "white cath" group (15.8% vs. 6.1%; p < 0.001). Conclusions In this cohort, approximately 9% of patients undergoing emergent coronary angiography for suspected STEMI had non-obstructive coronary arteries. Despite similar baseline characteristics, these patients exhibited higher 1-year mortality. This unexpectedly high mortality likely reflects a selection bias inherent to the activation of emergent catheterization protocols, underscoring the need for refined triage criteria, diagnostic approaches and management strategies in this heterogeneous population.
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Sanchez et al. (2026) conducted a cohort in Suspected STEMI (n=405). Non-obstructive coronary arteries vs. Obstructive coronary arteries (≥50% stenosis) was evaluated on 1-year mortality (p=<0.001). Non-obstructive coronary arteries in patients undergoing emergent angiography for suspected STEMI were associated with higher 1-year mortality than obstructive disease (15.8% vs 6.1%; p<0.001).
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