PMID- 38250703
OWN - NLM
STAT- MEDLINE
DCOM- 20240123
LR  - 20240201
IS  - 2211-8179 (Electronic)
IS  - 2211-8160 (Print)
IS  - 2211-8160 (Linking)
VI  - 19
IP  - 1
DP  - 2024
TI  - Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in 
      The Era of High-Sensitivity Cardiac Troponin.
PG  - 7
LID - 10.5334/gh.1286 [doi]
LID - 7
AB  - INTRODUCTION: High-sensitivity troponin (hsTn) has a very high diagnostic 
      accuracy for myocardial infarction (MI), and patients who were formerly diagnosed 
      with unstable angina (UA) are being reclassified as having NSTEMI in the era of 
      hsTn. This paradigm shift has changed the clinical features of UA, which remain 
      poorly characterized, specifically the occurrence of obstructive coronary artery 
      disease (CAD) and the need for myocardial revascularization. The main purpose of 
      this study was to clinically characterize contemporary UA patients, assess 
      predictors of obstructive CAD, and develop a risk model to predict significant 
      CAD in this population. METHODS: We conducted a retrospective cohort study of 742 
      patients admitted to the hospital with UA. All patients underwent coronary 
      angiography. The endpoint of the study was the presence of obstructive CAD on 
      angiography. The cohort was divided into two groups: patients with significant 
      coronary artery disease (CAD(+)) and those without CAD (CAD(-)). We developed a 
      score (UA CAD Risk) based on the multivariate model and compared it with the 
      GRACE, ESC, and TIMI risk scores using ROC analysis. RESULTS: Obstructive CAD was 
      observed on angiography in 53% of the patients. Age, dyslipidemia, troponin 
      level, male sex, ST-segment depression, and wall motion abnormalities on 
      echocardiography were independent predictors of obstructive CAD. hsTn levels 
      (undetectable vs. nonsignificant detection) had a negative predictive value of 
      81% to exclude obstructive CAD. We developed a prediction model with obstructive 
      CAD as the outcome (AUC: 0.60). CONCLUSIONS: In a contemporary UA cohort, 
      approximately 50% of the patients did not have obstructive CAD on angiography. 
      Commonly available cardiac tests at hospital admission show limited 
      discrimination power in identifying patients at risk of obstructive CAD. A 
      revised diagnostic and etiology algorithm for patients with UA is warranted.
CI  - Copyright: (c) 2024 The Author(s).
FAU - Paiva, Luis
AU  - Paiva L
AUID- ORCID: 0000-0002-9689-8155
AD  - Faculdade de Medicina, Universidade de Coimbra, Portugal.
AD  - Servico de Cardiologia, Centro Hospitalar e Universitario de Coimbra, Portugal.
FAU - Vieira, Maria Joao
AU  - Vieira MJ
AUID- ORCID: 0000-0001-6146-9652
AD  - Coimbra Institute for Clinical and Biomedical Research (iCBR), Universidade de 
      Coimbra, Portugal.
AD  - Servico de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria 
      da Feira, Portugal.
FAU - Baptista, Rui
AU  - Baptista R
AUID- ORCID: 0000-0002-7411-7039
AD  - Faculdade de Medicina, Universidade de Coimbra, Portugal.
AD  - Hospital Geral -Quinta dos Vales, 3041-801 Coimbra, Portugal.
FAU - Ferreira, Maria Joao
AU  - Ferreira MJ
AUID- ORCID: 0000-0001-8952-8618
AD  - Coimbra Institute for Clinical and Biomedical Research (iCBR), Universidade de 
      Coimbra, Portugal.
AD  - Servico de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria 
      da Feira, Portugal.
FAU - Goncalves, Lino
AU  - Goncalves L
AUID- ORCID: 0000-0001-9255-3064
AD  - Faculdade de Medicina, Universidade de Coimbra, Portugal.
AD  - Coimbra Institute for Biomedical Imaging and Translational Research, Universidade 
      de Coimbra, Portugal.
LA  - eng
PT  - Journal Article
DEP - 20240119
PL  - England
TA  - Glob Heart
JT  - Global heart
JID - 101584391
RN  - 0 (Troponin)
SB  - IM
MH  - Humans
MH  - Male
MH  - *Coronary Artery Disease/diagnosis/epidemiology
MH  - Retrospective Studies
MH  - Angina, Unstable/diagnosis/epidemiology
MH  - Troponin
MH  - Risk Assessment
PMC - PMC10798171
OTO - NOTNLM
OT  - high-sensitivity troponin
OT  - non-ST-segment elevation acute coronary syndrome
OT  - obstructive coronary artery disease
OT  - risk assessment
OT  - unstable angina
COIS- The authors have no competing interests to declare.
EDAT- 2024/01/22 06:42
MHDA- 2024/01/23 06:43
PMCR- 2024/01/19
CRDT- 2024/01/22 05:29
PHST- 2023/07/16 00:00 [received]
PHST- 2023/12/18 00:00 [accepted]
PHST- 2024/01/23 06:43 [medline]
PHST- 2024/01/22 06:42 [pubmed]
PHST- 2024/01/22 05:29 [entrez]
PHST- 2024/01/19 00:00 [pmc-release]
AID - 10.5334/gh.1286 [doi]
PST - epublish
SO  - Glob Heart. 2024 Jan 19;19(1):7. doi: 10.5334/gh.1286. eCollection 2024.