SPC365

Clinical trends in unstable angina after high-sensitive cardiac troponin introduction: a single centre analysis

Session: Posters (Sessão 6 - Écran 6) - Síndromes Coronárias Agudas e Crónicas
Speaker: Carolina Miguel Gonçalves

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.8 Coronary Artery Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Carolina Miguel Gonçalves; Adriana Vazão; Mariana Carvalho; Margarida Cabral; Sara Fernandes; Luis Graça Santos; Tiago Teixeira; Jorge Guardado; Fátima Saraiva; João Morais

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Unstable angina (UA) is defined as myocardial ischemia at minimal exertion or at rest without myocardial injury, an entity progressively less diagnosed after the introduction of high-sensitivity (hs) cardiac troponin (cTn) assays. Although elevated cTn levels carry worse prognosis among acute coronary syndrome (ACS) patients, little is known regarding the potential added value of hs assays in establishing the diagnosis of UA.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To compare the clinical characteristics, coronary angiography findings and major cardiovascular events (MACE) of UA patients before and after the introduction of hs-cTn assays.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Material and methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective single-centre analysis of 166 UA patients admitted for invasive stratification from 2015 to 2022. Two cohorts were defined according to the cTn assay used (hs-TnI vs conventional TnI) and its baseline characteristics, coronary angiography findings and associated extended MACE (median follow-up of 4 years) compared. In addition, multivariate logistic regression was performed to assess predictors of MACE in our population.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Overall, mean age was 64 <span style="font-family:Symbol">&plusmn;</span> 11 years, 72% were male, 35% had history of coronary artery disease (CAD), significant CAD was diagnosed in 50% and the incidence of MACE was 14%. Seventy-two UA cases (43%) were diagnosed using hs-cTn assay and ninety-four (57%) using non-hs cTn assays. Except for dyslipidemia, which was more frequent in the hs-cTn cohort (p=0.029), no differences were observed regarding cardiovascular risk factors, significant CAD and MACE. On multivariate analysis, body mass index (OR=0.850; CI 95% [<span style="color:black">0.735-0.983]; p=0.028), history of CAD (OR=2.839; [1.022-7.883]; p=0.045), significant CAD (OR=3.879; CI 95% [1.149-13.096]; p=0.029), hospital stay (OR=1.404; [1.018-1.937]; p=0.039 were associated with</span> MACE.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In our population of UA patients, clinical characteristics did not differ significantly regardless of the use of hs or non hs-cTn assays. Moreover, the introduction of hs cTn assays did not translate into better detection/exclusion of significant CAD or MACE improvement, which was relatively low in both groups. Accordingly, in the era of hs-cTn, UA patients remain a low-risk population of the ACS spectrum where other variables should be considered to better select those that may benefit from non-elective invasive stratification.</span></span></span></p>