Acute coronary syndrome with normal coronary arteries in patients with multiple sclerosis: insights from the ARTEMIS study.

Objectives - Multiple Sclerosis (MS) has been linked with the presence of coronary artery disease including Acute Coronary Syndrome with Normal Coronary Arteries (ACSNCA), but limited data exist regarding the underlying mechanisms. We aimed to explore potential classic risk factors and novel vascular biomarkers related to ACSNCA in MS patients. Methods - One hundred six patients with MS were enrolled. Two groups were defined according to the presence and/or history of ACSNCA. The presence of predisposing factors such as hypertension, diabetes, hyperlipidemia, smoking, obesity and family history was reported. Arterial stiffness and aortic wave reflections were also assessed by pulse wave velocity (PWV) and augmentation index, respectively, calculated by a validated, brachial cuff-based automated oscillometric device. Multiple logistic regression models were constructed to determine the strongest parameters related with the presence of ACSNCA. Results - Eleven patients with episodes of ACSNCA (Group-A) and 95 MS patients free of ACSNCA (Group-B) were identified. Among blood pressure parameters (peripheral and aortic), arterial stiffness and wave reflections, PWV had the strongest independent association with ACSNCA (enter-method). PWV values above 7 m/sec were related with the history of ACSNCA independently from age, diabetes and blood pressure. When all hemodynamic, arterial and classic risk factors were examined in a step-wise (backward) model diabetes and hyperlipidemia were the strongest independent factors associated with ACSNCA's presence. Conclusions - In MS patients, diabetes and hyperlipidemia represent the strongest, independent parameters related with the presence of ACSNCA. Arterial stiffness seems to play an underlying role in the development of ACSNCA which merits further investigation. [ABSTRACT FROM AUTHOR]