Incidence and 1-Year Prognostic of Unstable Angina After High-Sensitivity Troponin Assessment.

Abstract

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).