Predictors of Revascularization in Patients with Unstable Angina

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Feb 24

PMID 38398410

Authors

Jan Budzianowski

Wojciech Faron

Janusz Rzezniczak

Marek Slomczynski

Dariusz Hiczkiewicz

Jacek Olejniczak

Jaroslaw Hiczkiewicz

Pawel Burchardt

Affiliations

Soon will be listed here.

Abstract

Background: The factors that determine the necessity of coronary artery revascularization in patients with unstable angina (UA) have been supported by limited data. Therefore, this study aimed to identify the predictors of revascularization in patients with UA.

Methods: The study included the recorded data of 3668 patients with UA who underwent cardiac catheterization (age 66 ± 9.2, men 70%); 2615 of them (71%) underwent revascularization (percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), or hybrid revascularization. The remaining 1053 patients (29%) had no significant coronary stenosis and were regarded as controls. Multivariable logistic regression analysis was performed to separate the predictors of revascularization.

Results: It was found that severe angina (OR 2.7, 95%CI 1.9-3.7), male gender (OR 1.4, 95%CI 1.1-1.7), and hyperlipidemia were the predictors of revascularization. It was also noted that intraventricular conduction disorders including left and right bundle branch blocks and a history of previous revascularization and myocardial infarction were associated with lower odds of revascularization.

Conclusion: Overall, however, the predictive value of the studied factors proved to be poor and may still point to the multifactorial nature of significant coronary artery stenosis and the need for revascularization in patients with UA.

References

Gul M, Uyarel H, Ergelen M, Karacimen D, Ugur M, Turer A . The relationship between red blood cell distribution width and the clinical outcomes in non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up. Coron Artery Dis. 2012; 23(5):330-6. DOI: 10.1097/MCA.0b013e3283564986. View

Shah A, Anand A, Strachan F, Ferry A, Lee K, Chapman A . High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. Lancet. 2018; 392(10151):919-928. PMC: 6137538. DOI: 10.1016/S0140-6736(18)31923-8. View

Mobley B, Schechter E, Moore W, McKee P, Eichner J . Neural network predictions of significant coronary artery stenosis in men. Artif Intell Med. 2005; 34(2):151-61. DOI: 10.1016/j.artmed.2004.08.003. View

Wallentin L, Becker R, Budaj A, Cannon C, Emanuelsson H, Held C . Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361(11):1045-57. DOI: 10.1056/NEJMoa0904327. View

Yao W, Gao Y, Wan Z . Serum Metabolomics Profiling to Identify Biomarkers for Unstable Angina. Biomed Res Int. 2017; 2017:7657306. PMC: 5463165. DOI: 10.1155/2017/7657306. View

Sinning C, Lillpopp L, Appelbaum S, Ojeda F, Zeller T, Schnabel R . Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol. 2013; 102(7):495-503. DOI: 10.1007/s00392-013-0555-4. View

Sandoval Y, Apple F, Smith S . High-sensitivity cardiac troponin assays and unstable angina. Eur Heart J Acute Cardiovasc Care. 2016; 7(2):120-128. DOI: 10.1177/2048872616658591. View

Dsouza M, Sarkisian L, Saaby L, Poulsen T, Gerke O, Larsen T . Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. Am J Med. 2015; 128(8):852-60. DOI: 10.1016/j.amjmed.2015.01.044. View

Morrow D . Cardiovascular risk prediction in patients with stable and unstable coronary heart disease. Circulation. 2010; 121(24):2681-91. DOI: 10.1161/CIRCULATIONAHA.109.852749. View

10.

Eggers K, Jernberg T, Lindahl B . Unstable Angina in the Era of Cardiac Troponin Assays with Improved Sensitivity-A Clinical Dilemma. Am J Med. 2017; 130(12):1423-1430.e5. DOI: 10.1016/j.amjmed.2017.05.037. View

11.

Partida R, Libby P, Crea F, Jang I . Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. Eur Heart J. 2018; 39(22):2070-2076. PMC: 5991215. DOI: 10.1093/eurheartj/ehx786. View

12.

Katus H, Remppis A, Looser S, Hallermeier K, Scheffold T, Kubler W . Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. J Mol Cell Cardiol. 1989; 21(12):1349-53. DOI: 10.1016/0022-2828(89)90680-9. View

13.

Reichlin T, Twerenbold R, Maushart C, Reiter M, Moehring B, Schaub N . Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays. Am Heart J. 2013; 165(3):371-8.e3. DOI: 10.1016/j.ahj.2012.11.010. View

14.

Melanson S, Morrow D, Jarolim P . Earlier detection of myocardial injury in a preliminary evaluation using a new troponin I assay with improved sensitivity. Am J Clin Pathol. 2007; 128(2):282-6. DOI: 10.1309/Q9W5HJTT24GQCXXX. View

15.

Sun L, Zhang C, Ju Y, Tang B, Gu M, Pan B . Mean Corpuscular Volume Predicts In-Stent Restenosis Risk for Stable Coronary Artery Disease Patients Receiving Elective Percutaneous Coronary Intervention. Med Sci Monit. 2019; 25:3976-3982. PMC: 6559005. DOI: 10.12659/MSM.914654. View

16.

Apple F, Jaffe A, Collinson P, Mockel M, Ordonez-Llanos J, Lindahl B . IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem. 2014; 48(4-5):201-3. DOI: 10.1016/j.clinbiochem.2014.08.021. View

17.

Shah A, Anand A, Sandoval Y, Lee K, Smith S, Adamson P . High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet. 2015; 386(10012):2481-8. PMC: 4765710. DOI: 10.1016/S0140-6736(15)00391-8. View

18.

Demirkol S, Balta S, Unlu M, Yuksel U, Celik T, Arslan Z . Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sao Paulo). 2012; 67(9):1019-22. PMC: 3438240. DOI: 10.6061/clinics/2012(09)06. View

19.

Thygesen K, Alpert J, Jaffe A, Chaitman B, Bax J, Morrow D . Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138(20):e618-e651. DOI: 10.1161/CIR.0000000000000617. View

20.

Qazmooz H, Smesam H, Mousa R, Al-Hakeim H, Maes M . Trace element, immune and opioid biomarkers of unstable angina, increased atherogenicity and insulin resistance: Results of machine learning. J Trace Elem Med Biol. 2020; 64:126703. DOI: 10.1016/j.jtemb.2020.126703. View