Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population. (October 2022)

• Record Type: Journal Article
• Authors: Fladseth, Kristina; Wilsgaard, Tom; Lindekleiv, Haakon; Kristensen, Andreas; Mannsverk, Jan; Løchen, Maja-Lisa; Njølstad, Inger; Mathiesen, Ellisiv B; Trovik, Thor; Rotevatn, Svein; Forsdahl, Signe; Schirmer, Henrik
• Is Part Of: IJC heart & vasculature. Volume 42(2023)
• Publication Date: 2022-10
• Subjects: High-sensitivity troponins -- Non-ST elevation acute coronary syndrome -- Non-obstructive coronary artery disease -- Prognosis; CABG Coronary artery bypass graft -- CAD Coronary artery disease -- CCTA Coronary computed tomography angiography -- ESC European Society of Cardiology -- FFR Fractional flow reserve -- Hs-cTn High-sensitivity troponin -- ICA Invasive coronary angiography -- MACE Major cardiovascular events -- MI Myocardial infarction -- NORIC Norwegian Registry of Invasive Cardiology -- NSTE-ACS Non-ST-segment elevation acute coronary syndrome -- NSTEMI Non-ST-segment elevation myocardial infarction -- PCI Percutaneous coronary intervention -- SA Stable angina -- STEMI ST-segment elevation myocardial infarction -- UA Unstable angina; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101099
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: The outcomes of real-world unstable angina (UA) in the high-sensitivity troponin era are unclear. We aimed to investigate the outcomes of UA referred to coronary angiography compared to stable angina (SA), non-ST-segment elevation myocardial infarction (NSTEMI), STEMI and a general population. Methods: We included the 9, 694 patients with no prior coronary artery disease (CAD) referred to invasive or CT coronary angiography from 2013 to 2018 in Northern Norway (51% SA, 12% UA, 23% NSTEMI and 14% STEMI), and 11, 959 asymptomatic individuals recruited from the Tromsø Study. We used Cox models to estimate the hazard ratios (HR) for all-cause mortality and major adverse cardiovascular events (MACE), defined as cardiovascular death, MI or obstructive CAD. Results: The median follow-up time was 2.8 years. The incidence rate of death was 8.5 per 1000 person-years (95 % confidence interval [CI] 8.0–9.0) in the general population, 9.7 (95 % CI 8.3–11.5) in SA, 14.9 (95 % CI 11.4–19.6) in UA, 29.7 (95 % CI 25.6–34.3) in NSTEMI and 36.5 (95 % CI 30.9–43.2) in STEMI. In multivariable adjusted analyses, compared with UA, SA had a 38 % lower risk of death and a non-significant lower risk of MACE (HR 0.62, 95 % CI 0.44–0.89; HR 0.86, 95 % CI 0.66–1.11). NSTEMI had a 2.4-fold higher risk of death (HR 2.39, 95 % CI 1.38–4.14) and a 1.6-fold higher risk of MACE (HR 1.62, 95 % CI 1.11–2.38) compared tox UA during the first year after coronary angiography, but a similar risk thereafter. There was no difference in the risk of death for UA with non-obstructive CAD and obstructive CAD (HR 0.78, 95 % CI 0.39–1.57). Conclusion: UA had a higher risk of death but a similar risk of MACE compared to SA and a lower 1-year risk of death and MACE compared to NSTEMI.