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My patient has a positive ischemia test: will he have obstructive coronary artery disease?
Session:
Posters (Sessão 1 - Écran 6) - DAC e Cuidados Intensivos 1 - Síndromes Coronários Crónicos
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Raquel Menezes Fernandes; Hugo Alex Costa; Miguel Espírito Santo; Dina Bento; João Pedro Guedes; Hugo Vinhas; Ilídio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Functional non-invasive tests are useful to detect myocardial ischemia in patients with chronic coronary syndrome (CCS). However, their false positive rate is not negligible.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To characterize CCS patients referred to coronary angiography (CA) after a positive ischemia test, in whom obstructive coronary artery disease (CAD) is detected.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We conducted a retrospective study enrolling CCS patients referred to CA in our Cardiology Department from October 2018 to January 2021, after a positive ischemia test. Clinical and complementary diagnostic exams characteristics, and follow-up data were analysed. Obstructive CAD was defined as the presence of at least one stenosis ≥70% (>50% if left main coronary artery (LMCA)). Primary endpoint was the composite of myocardial infarction (MI), all-cause hospitalization and mortality.</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Results:</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> During this period, 236 CCS patients were referred to CA, with a median age of 67 years-old and male predominance (76,6%). The prevalence of cardiovascular risk factors was high and 79,5% of patients were in Canadian Cardiovascular Society class II. The majority only performed exercise electrocardiogram (ECG) (62,7%), followed by myocardial perfusion scintigraphy (MPS) (25%) and stress echocardiogram (9,7%). Stress echocardiogram was the ischemia test with higher sensitivity (78,3%), while MPS had the lowest sensitivity (54,2%). 65,7% of patients had obstructive CAD and coronary intervention was performed in 96%. The rate of severe CAD was 47,9% (LMCA – 8,5%, proximal left anterior descendent artery stenosis – 25%; multivessel disease – 38,6%) and 26,3% had at least one chronic total occlusion. Major procedural complications (p.e. MI, stroke and death) occurred in 2,1%. Patients with obstructive CAD were predominantly male (84,5% vs 61,7%; p<0,001), had a larger prevalence of previous percutaneous coronary intervention (23,2% vs 12,3%; p=0,045) and a higher pre-test probability (33,91±13,9% vs 27,27±12,5%; p=0,003). 82,2% had chest pain and 83,7% had preserved left ventricle ejection fraction. Patients that had a clinical and electrically positive exercise ECG had a larger prevalence of obstructive CAD (81,8% vs 56,1%; p=0,01). After multivariable analysis, only chest pain was an independent predictor of obstructive CAD (odds ratio = 3,17 [1,31-7,62]; p=0,01). During a median follow-up of 428 days, primary endpoint occurred in 12,1% of patients, with no statistically significant difference depending on the presence of obstructive CAD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our study, 65,7% of CCS patients with a positive ischemia test had obstructive CAD (severe in 47,9%). Stress echocardiogram was more sensitive in detecting CAD, and MPS was the least sensitive. However, chest pain was the only independent predictor of obstructive CAD in our population, reinforcing the role of an accurate clinical history in the management of these patients.</span></span></p>
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