Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome

Abstract

Background: Current risk assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) may fail to identify some patients with severe coronary artery disease (CAD). We aimed to identify predictors of the angiographic extent and severity of CAD in patients with NSTE-ACS undergoing early angiography and to evaluate its impact on prognosis. Methods: We evaluated 923 patients with NSTE-ACS who underwent coronary angiography. High-risk coronary anatomy (HRCA) was defined as left main disease > 50%, proximal LAD lesion > 70%, or 2-to 3-vessel disease involving the LAD. Clinical characteristics, in-hospital, and 30-day outcome and 1-year mortality were compared between the high-risk (N 5 370) and the low-risk groups (N 5 553). Results: Proportion of patients with elevated cardiac biomarkers was similar in both groups. The presence of peripheral vascular disease (OR 5 1.88, 95% confidence interval [CI] 5 1.62-5.80, P < 0.001) and a GRACE score of >140 (OR 5 1.88, 95% CI 5 1.29-2.75, P < 0.001) were the strongest predictors of HRCA. Patients with HRCA were prone to more complications during hospitalization and at 30 days (11.9% vs. 6%, P < 0.01) and increased 1-year mortality (6.7% vs. 0.9%, P < 0.001). HRCA was the strongest predictor for 30-day MACCE (OR 5 2.32, 95% CI 5 1.42-3.79, P < 0.001). HRCA (OR 5 8.36, 95% CI 5 1.01-69.4, P 5 0.049; OR 5 3.64, 95% CI 5 1.2-11.07, P 5 0.02) and GRACE score of >140 (OR 5 6.86, 95% CI 5 1.68-27.9, P 5 0.007; OR 5 4.84, 95% CI 5 1.74-13.5, P 5 0.002) were significant predictors of 30-day and 1-year mortality, respectively. Conclusions: HRCA is predicted by clinical parameters and was not associated with elevated cardiac biomarkers. These patients fared worse when compared with those with low-risk anatomy. We suggest that HRCA predictors should be included in the risk stratification of patients with NSTE-ACS. V C 2013 Wiley Periodicals, Inc.

Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin

“…Moreover, the overall burden of coronary lesions is lower in AIS patients than in NSTE-ACS patients despite similar baseline cTn levels and GRACE scores (both correlating with severity of coronary lesions and TIMI flow rates in ACS patients). [14][15][16] Despite the angiographic evidence of a coronary culprit lesion in ≈25% of AIS patients, all but 1 patient had TIMI III flow beyond the culprit artery, and the majority were treated conservatively during the acute phase after ischemic stroke. Given that there is substantial overlap between the plaque anatomy of putatively stable and acute coronary disease, 17,18 the context of clinical complaints and typical ECG findings is needed to establish the diagnosis of an ACS.…”

Assessment of Relationship for Grace Score and Coronary Lesion Severity in Young Patients With Acute Coronary Syndrome

“…Одним из факторов, который учитывают у больных с ОКС↓ST при определении показаний к КАГ, является расчетный риск по шкале GRACE. Предполагается наличие корреляции между степенью риска по шкале GRACE и тяжестью поражения коронарного русла, которое является независимым предиктором неблагоприятного прогноза [7], что продемонстрировано в ряде работ [8]. Однако, по мнению других авторов, корреляция между коронарной анатомией и расчетным риском отсутсвует [10,11].…”

“…[4]. В ряде исследований продемонстрирована высокая прогностическая ценность шкалы GRACE для пациентов с ОКС↓ST в определении краткосрочного и долгосрочного прогнозов [5][6][7], а также выявлена взаимосвязь риска по GRACE c тяжестью поражения коронарного русла [8]. В то же время, по мнению некоторых авторов, прогностическая значимость шкалы GRACE вызывает сомнения [9,10].…”

Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes

“…Moreover, multivessel CAD is one of the most common causes of higher risk for cardiovascular morbidity and mortality in this population [5,6]. Although, an early invasive approach in patients with moderate-to-high risk is recommended, management of patients with confirmed multivessel CAD is controversial [7][8][9].…”