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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Unstable angina in the era of high sensitivity troponin: a clinical dilemma?
Session:
Posters 4 - Écran 2 - Doença Coronária
Speaker:
Maria João Matos Vieira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Maria João Matos Vieira; João Gameiro; Luís Puga; Liliana Reis; Joana M. Ribeiro; Luis Paiva; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Introduction: </strong>Due to widespread use of high sensitive cardiac troponin (hs-cTn) assays, the patients (pts) that were formerly included in the diagnosis of unstable angina (UA) group, are now being classified as NSTEMI patients. With this paradigm shift, the truly unstable angina patients (troponin negative) represent a new entity of lesser cardiovascular risk, however poorly characterized.</p> <p><strong>Objectives:</strong> To assess prognosis and its predictors in pts with UA submitted to percutaneous revascularization (PCI).</p> <p><strong>Methods:</strong> Retrospective study with 229 pts admitted to emergency service between 01/01/2013 and 11/30/2017 and classified as a high probability of unstable angina by a senior cardiologist. Of these pts, those with significant coronary artery disease that underwent PCI (n=93) were included in the analysis. The primary outcome was the presence of adverse cardiovascular events (AMI, stroke or death – MACE) during the follow-up period (747±525 days). These pts were divided into two groups, according to the primary outcome: Group A (GpA), patients with MACE occurrence; Group B (GpB), patients without MACE occurrence. Demographic, clinical, electrocardiographic, echocardiographic and angiographic data were evaluated.</p> <p><strong>Results:</strong> The primary outcome was observed in 9 pts (10,3%). Mortality rate was 4,6% (2,3% from cardiovascular cause). Age (GpA 75,9±6,2 vs GpB 67,6±9,2 years; P=0,011), hemoglobin levels (GpA 12,5±1,2 vs GpB 13,8±1,7 mg/dl; P=0,031), hsT (GpA 0,022±0,008 vs GpB 0,015±0,006 ng/dl; P=0,002) and glomerular filtration rate (MDRD) (GpA 61,0±22,8 vs GpB 84,3±30,7 mL/min/1.73 m2; P=0,011) were the parameters associated with the occurrence of MACE in the univariate analysis. Concerning angiographic parameters, including the affected vessel, number of vessels with significant stenosis and number of significant lesions, no risk factors associated with poor prognosis were identified.</p> <p>In the multivariate analysis the only independent predictor of MACE occurrence was the hsT concentration on admission (ß=123; P=0,032), with levels between 0,013 ng/ml and the lower reference limit (0,034 ng/ml) estimated to have a sensitivity of 89% and a specificity of 60% for the occurrence of MACE.</p> <p><strong>Conclusions: </strong>In this study, this UA population was considered a low risk population, with a low MACE incidence. High sensitivity troponin levels, even below the lower reference limits, were strong predictors of long-term events. These results underline the value of hsT not only as a lesion discriminator in an acute context but also as a predictor of prognosis in the long term, rising the debate about the need of refinement of the severity criteria, to achieve better risk stratification in an emergency context.</p>
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