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Incidence and 1-Year Prognostic of Unstable Angina After High-Sensitivity Troponin Assessment
Romain Jouen1, Pierre-Alain Meunier1, Lionel Moulis2
1Department of Cardiology, University of Montpellier, Montpellier, France.
Insights
Unstable angina (UA) with significant coronary artery disease (CAD) is uncommon but carries a high 1-year cardiac event rate, primarily new acute coronary syndromes (ACS). Enhanced secondary prevention is vital for these patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- The prognostic implications of unstable angina (UA) diagnosed using high-sensitivity troponin (hs-cTn) assays remain debated.
- Contemporary data on UA incidence and outcomes in patients with significant coronary artery disease (CAD) are limited.
Purpose of the Study:
- To evaluate the prognosis of a contemporary patient cohort with UA, defined by hs-cTn measurements, and significant CAD.
- To identify factors associated with major adverse cardiac events at 1-year follow-up.
Main Methods:
- A prospective study included 210 patients with UA and significant CAD across two French university centers.
- UA was defined by clinical symptoms and hs-cTn levels (undetectable, non-elevated, or mildly elevated).
- The primary endpoint was major adverse events at 1-year, with secondary analysis of risk factors.
Main Results:
- The incidence of UA with significant CAD was 12.0% (210/1752 patients), with predominantly male patients and a history of CAD in 46.6%.
- At 1-year, 26.2% of patients experienced major adverse events, mainly new ACS (16.2%).
- History of CAD, multivessel disease, and multiple risk factors were significantly associated with 1-year adverse events, not troponin levels.
Conclusions:
- Unstable angina with significant CAD is infrequent but associated with a substantial 1-year risk of cardiac events, predominantly new ACS.
- Improving secondary prevention strategies is critical for managing this high-risk patient group.
- The study identified key predictors of adverse outcomes, guiding risk stratification.
Background:
Incidence and prognostic of unstable angina after high-sensitivity troponin assesment is controversial.
Aims:
This study evaluated prognostic of a contemporary population of patients with UA defined using high sensitive T troponin (T hs-cTn) measurements and with significant coronary artery disease (CAD).
Methods:
Consecutive patients admitted in 2 French university centres with UA defined as clinical ischemic symptoms and T hs-cTn dosages undetectable (< 5 ng/L), non-elevated (> 14 ng/L) or mildly elevated (14-50 ng/L) were included. The primary end-point included major events at 1-year follow-up.
Results:
Among 1752 patients admitted for ACS between December 2021 and February 2023, 210 (12.0%) have UA and significant CAD. Mean age was 66 ± 12 years, with predominantly men (n = 143; 68.1%). Patients had undetectable (n = 4), non-elevated (n = 80) or mildly elevated and stable T hs-cTn (n = 126). History of CAD was found in 98 patients (46.6%). Percutaneous intervention was required in main patients (n = 186; 88.6%). Adverse non-fatal in-hospital event occurred in one patient. The primary outcome was achieved in 55 patients (26.2%; CI 95% [20.2-32.1]) mainly related to new ACS (n = 34, 16.2%). The level of troponin at admission (p = 0.639) was not associated with the primary outcome. In multivariate analysis, multiple risk factors (OR 1.93, [1.01-3.69], p = 0.0194), history of CAD (3.09; CI [1.63; 5.87], p = 0.0005), and tritroncular disease (OR 2.66; CI [1.24; 5.69], p = 0.0118) were significantly associated with major events at 1-year.
Conclusion:
Contemporary incidence of UA with significant CAD is low with few in-hospital events, but with a 1-year incidence of cardiac events high (26%), mainly related to new ACS. Improving secondary prevention may be crucial for these patients. (ID: NCT06378333).
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