Methods: We analyzed all consecutive patients during the years 1996 to 2002 undergoing urgent coronary angiography (n=897) in our institution and presenting a normal angiogram (n=76, 8.5%). We analyzed angiographic findings and the clinical follow-up over a period of 9 months.

Results: A total of 76 patients (71.1% male, 53+13.8 years) with ACS normal angiogram. The indication for angiography were: unstable angina (80.3%) and acute myocardial infarction (19.7%). Thrombolysis and glycoprotein IIb/IIIa-blockers were administered prior to angiography in 7.9% and 11.8%, respectively. Electrocardiographic findings included ST-elevation (10.5%), ST-depression (36.8%) and left bundle branch block (10.5%). Creatine kinase and troponin T were elevated prior to angiography in 21.1% and 30.6%, respectively. Angiographic and further diagnostic findings were: coronary spasms (6.6%), myocardial bridges (5.3%), cardiomyopathy (2.6%), hypertensive heart disease (14.5%) and pericarditis (10.5%). 60.5% of patients remained without any specific diagnosis. Nine patients were readmitted during follow-up of 9 months, three patients due to thoracic pain, of those two patients without ischemia, in one patient an acute myocardial infarction occurred.