Figure 1
Flow diagram of the study.
CAD–, no obstructive coronary artery disease; CAD+, presence of significant coronary artery disease; UA, unstable angina.
Table 1
Baseline characteristics of patients with clinical diagnosis of unstable angina.
| UNSTABLE ANGINA | ||||
|---|---|---|---|---|
| POPULATION | TOTAL n = 742 | CAD– n = 347 (47%) | CAD+ n = 395 (53%) | p |
| Male (%) | 506 (69) | 216 (62) | 292 (74) | <0.001 |
| Age (years ± SD) | 66 ± 11.1 | 65 ± 11.5 | 67 ± 10.7 | 0.003 |
| BMI (Kg/m2 ± SD) | 28.1 ± 4.0 | 28.1 ± 4.2 | 28.1 ± 3.9 | 0.87 |
| HTN (%) | 622 (84) | 279 (80) | 343 (87) | 0.018 |
| Dyslipidaemia (%) | 626 (84) | 272 (78) | 354 (90) | <0.001 |
| Diabetes Mellitus (%) | 260 (35) | 104 (30) | 156 (40) | 0.007 |
| Current/Past Smoking (%) | 243 (33) | 108 (31) | 135 (34) | 0.27 |
| CKD (%) | 75 (10) | 30 (9) | 45 (11) | 0.22 |
| Previous MI (%) | 153 (21) | 57 (16) | 96 (24) | 0.008 |
| Previous PCI (%) | 211 (29) | 77 (22) | 134 (34) | <0.001 |
| Previous CABG (%) | 39 (5) | 0 (0) | 39 (9.9) | <0.001 |
| Aspirin (%) | 569 (77) | 251 (72) | 318 (81) | 0.009 |
| P2Y12 receptor inhibitor (%) | 266 (36) | 4 (1) | 262 (66) | <0.001 |
| Statin (%) | 621 (84) | 293 (84) | 328 (83) | 0.61 |
| ACE inhibitor or ARB (%) | 622 (84) | 279 (80) | 343 (87) | 0.020 |
| Oral anticoagulant (%) | 90 (12) | 44 (13) | 46 (12) | 0.670 |
| Beta-Blocker (%) | 470 (63) | 141 (41) | 329 (83) | <0.001 |
| Admission | ||||
| Killip-Kimball Class (%) | 0.50 | |||
| Class 1 | 700 (94.3) | 330 (95.1) | 370 (93.7) | |
| Class 2 | 41 (5.5) | 17 (4.9) | 24 (6.1) | |
| Class 3 | 1 (0.1) | 0 (0) | 1 (0.3) | |
| Class 4 | 0 (0) | 0 (0) | 0 (0) | |
| SBP (mmHg ± SD) | 135 ± 21 | 133 ± 21 | 136 ± 22 | 0.034 |
| Heart Rate (/min ± SD) | 67 ± 13 | 69 ± 13 | 67 ± 12 | 0.19 |
| Creatinine (µmol/L ± SD)) | 90.5 ± 65 | 84.8 ± 47 | 95.5 ± 78 | 0.026 |
| NTproBNP (pg/ml ± SD)) | 637 ± 1875 | 685 ± 2389 | 580 ± 972 | 0.74 |
| hsTn (ng/ml ± SD)) | 0.0157 ± 0.007 | 0.0145 ± 0.006 | 0.0168 ± 0.009 | <0.001 |
| ECG abnormalities (%) | 372 (50) | 167 (48) | 205 (52) | 0.32 |
| ECG ST deviation (%) | 95 (13) | 33 (10) | 62 (16) | 0.012 |
| LVEF (% ± SD) | 55.5 ± 7.9 | 56.6 ± 7.2 | 54.4 ± 8.3 | <0.001 |
| Echocardiographic WMA (%) | 223 (32) | 73 (22) | 150 (40) | <0.001 |
| Grace Score | ||||
| In-hospital | 111 (25.5) | 107.7 (26.3) | 112.2 (24.7) | 0.017 |
| 6 months | 94.9 (24.5) | 92.1 (25.2) | 97.3 (23.7) | 0.004 |
| Treatment | ||||
| PCI (%) | 266 (36%) | 0 | 266 (67%) | <0.001 |
| CABG (%) | 72 (10%) | 0 | 72 (20%) | <0.001 |
[i] ACE inhibitors – angiotensin-converting enzyme; ARB – angiotensin receptor blocker; BMI – body mass index; CABG – coronary artery bypass grafting; CAD+ obstructive coronary artery disease; CAD – without obstructive coronary artery disease; CKD chronic kidney disease; DBP diastolic blood pressure; ECG 12-lead electrocardiogram; HsTn high sensitivity troponin; HTN arterial hypertension; LVEF left ventricular ejection fraction; MI myocardial infarction; NTproBNP N-terminal proB-type natriuretic peptide; PCI percutaneous coronary intervention; SBP systolic blood pressure; WMA wall motion abnormalities by transthoracic echocardiogram.
Table 2
Multivariate logistic regression for predictors of obstructive coronary artery disease in unstable angina patients.
| β COEF. | IC 95% | p | |
|---|---|---|---|
| Male | 0.532 | 0.186–0.879 | 0.003 |
| Age | 0.025 | 0.002–0.478 | 0.032 |
| Arterial Hypertension | 0.216 | –0.225–0.657 | 0.337 |
| Dyslipidaemias | 0.648 | 0.190–1.107 | 0.006 |
| Diabetes Mellitus | 0.203 | –0.134–0.540 | 0.239 |
| Creatinine | 0.001 | –0.002–0.004 | 0.495 |
| HsTn | 31.935 | 9.956–53.923 | 0.004 |
| WMA | 0.308 | 0.097–0.519 | 0.004 |
| ECG ST Deviation | 0.745 | 0.191–1.298 | 0.008 |
| In-hospital GRACE score | –0.006 | –0.161–0.004 | 0.264 |
[i] ECG 12-lead electrocardiogram; hsTn high sensitivity troponin; MI myocardial infarction; WMA wall motion abnormalities by transthoracic echocardiogram.
Table 3
The weight variables in the UA CAD Risk model.
| MULTIVARIATE MODEL | β COEF. (95% CI) | p |
|---|---|---|
| Sex | 0.519 (0.173–0.855) | 0.003 |
| Age | 0.175 (0.003–0.032) | 0.017 |
| Dyslipidaemia | 0.736 (0.290–1.182) | 0.001 |
| hsTn | 32.399 (10.785–54.012) | 0.003 |
| WMA | 0.331 (0.122–0.539) | 0.002 |
| ECG ST Deviation | 0.579 (0.105–1.053) | 0.017 |
| Constant | – 2.745 |
[i] ECG 12-lead electrocardiogram; hsTn high sensitivity troponin; MI myocardial infarction; WMA wall motion abnormalities by transthoracic echocardiogram.
UA CAD Risk:
= e^(–0.122 + (0.175*Age) + (0.519*Sex) + (0.736*Dyslipidaemia) + (32.399*hsTN) + (0.331*WMA) + (0.579*ECG ST Deviation)) / 1 + e^(–0.122 + (0.175*age) + (0.519*Sex) + (0.736*Dyslipidaemia) + (32.399*hsTN) + (0.331*WMA) + (0.579*ECG ST Deviation))
Sex: male = 0; female = 1; Dyslipidaemia: absence = 0, presence = 1; WMA: absence = 0, presence = 1; ECG ST Deviation: absence = 0, presence = 1.
Figure 2
Receiver operating characteristic (ROC) curves with obstructive CAD as the outcome, comparing UA CAD Risk, GRACE, ESC, and TIMI risk scores.
ESC European Society of Cardiology criteria, GRACE The Global Registry of Acute Coronary Events; TIMI Thrombolysis in Myocardial Infarction criteria; UA Unstable Angina.
CAD–, no obstructive coronary artery disease; CAD+, presence of significant coronary artery disease; UA, unstable angina.
Figure 3
Main findings of the study.
CABG, coronary artery bypass graft; CAD–, no obstructive coronary artery disease; CAD+, presence of obstructive coronary artery disease; DET, detectable hsTn levels; ECG, 12-lead electrocardiography; ECHO, transthoracic echocardiogram; WMA, ventricular wall motion abnormalities; NR, no myocardial revascularization; N, no relevant finding; PCI, percutaneous coronary intervention; ST, ST-segment changes; T, T-wave changes; UA, unstable angina; UND, undetectable hsTn levels.