Unstable Angina Risk Stratification Using High-Sensitivity Cardiac Troponin and Coronary Angiography

Luis Manuel Vilardouro Paiva; Maria João Vieira; Mariana Simões; Maria João Ferreira; Lino Gonçalves

doi:10.1016/j.amjcard.2024.03.034

Unstable Angina Risk Stratification Using High-Sensitivity Cardiac Troponin and Coronary Angiography

Am J Cardiol. 2024 Apr 3:221:1-8. doi: 10.1016/j.amjcard.2024.03.034. Online ahead of print.

Authors

Luis Manuel Vilardouro Paiva¹, Maria João Vieira², Mariana Simões², Maria João Ferreira³, Lino Gonçalves⁴

Affiliations

¹ Medical Faculty, Coimbra University, Portugal; Cardiology Department, Coimbra University Hospital Centre, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra University, Portugal. Electronic address: luisvpaiva@gmail.com.
² Cardiology Department, Coimbra University Hospital Centre, Portugal.
³ Medical Faculty, Coimbra University, Portugal; Cardiology Department, Coimbra University Hospital Centre, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra University, Portugal.
⁴ Medical Faculty, Coimbra University, Portugal; Cardiology Department, Coimbra University Hospital Centre, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra University, Portugal.

PMID: 38580042
DOI: 10.1016/j.amjcard.2024.03.034

Abstract

Patients formerly diagnosed with unstable angina (UA) are being reclassified as non-ST-elevation myocardial infarction with the widespread adoption of high-sensitivity troponin (hsTn) assays, leading to significant changes in the incidence and prognosis of UA. This study aimed to evaluate the value of hsTn and the presence of significant obstructive coronary artery disease (CAD) in the risk stratification of patients with UA. We conducted a retrospective, single-center study of 742 patients hospitalized for UA between 2016 and 2021. The primary end point of this study was all-cause mortality. The secondary outcome (major adverse cardiac events [MACEs]) was defined as a composite of nonfatal myocardial infarction (MI), hospitalization for heart failure (hHF), and repeated coronary angiography because of recurring UA (rUA) after the index event. The outcomes were assessed within 1 month, 1 year, and up to 5 years of follow-up. The average follow-up duration was 45 ± 24 months, and 37.2% (n = 276) of patients completed a 5-year follow-up. No in-hospital death was observed, and 6.9% of patients died during follow-up, which was more commonly a late event (>12 months). The composite secondary end point (MI+hHF+rUA) was observed in 16.7% of the patients. There were 3.2% nonfatal MI, 2.3% hHF, and 11.6% rUA during follow-up. We developed a risk model (UA mortality risk) using variables with the highest discriminatory power: age, hsTn, and ST-segment deviation. Our model performed well against the Global Registry of Acute Coronary Events and Thrombolysis in Myocardial Infarction risk scores in predicting death during follow-up. Obstructive CAD on coronary angiography was the only independent predictor of MACEs during follow-up. In conclusion, a contemporary cohort of patients with UA presented with favorable prognosis, particularly, within the first year after the index event. Nonsignificant increases in hsTn levels add to the risk stratification of patients with UA, and the presence of obstructive CAD was the only independent predictor of MACEs, highlighting the potential importance of assessing coronary anatomy.

Keywords: coronary artery disease; high-sensitivity troponin; non-ST-segment elevation acute coronary syndrome; prognosis; unstable angina.