P3676Prognosis of an invasive approach to unstable angina

Abstract

Background: Most of the large randomized control trials included patients with unstable angina (UA) together other acute coronary syndromes patients. This approach implies a prognosis for such UA patients that may be overestimated in the high-sensitivity troponin assays era. Purpose: The purpose of this paper was to assess the prognosis of a contemporary sample of UA patients submitted to a coronary angiography. Methods: Retrospective study of patients admitted consecutively to the emergency department for UA between January 2013 and November 2016 who performed coronary angiography during hospitalization. We analysed the characteristics that were predictive of an adverse cardiovascular outcome during follow up (mean time for mortality, acute myocardial infarction (AMI) or need for revascularization). Results: The sample consisted of 259 patients (67±12 years old, 70% male). There was a high prevalence of established coronary artery disease (prior AMI: 28,6%; previous coronary artery bypass graft: 8,1%; history of percutaneous coronary intervention: 35,5%). The mean follow-up (FU) time was 11,7±9 months. There were no observed cases of in-hospital mortality and only 1 case of death at 1 month of FU. All-cause mortality during FU occurred in 11 patients (4,2%), in whom 40% (N=4) was of cardiovascular cause. Mean survival time was 32,9 months. Myocardial infarction rate during FU was 0,8% (N=2) and readmission for angina happened in 23 patients (8,9%). Revascularization at index event, either percutaneous or surgical, was observed in 34% of our sample (N=88). In univariate analysis, age (P=0.014), estimated glomerular filtration (calculated with MDRD equation) at admission (P=0.022), presence of ST segment depression (P=0.009) and of pathological q waves in the ECG (P=0.009) were statistically associated with mortality during the follow-up. None of the findings in the coronary angiography (number of angiographically significant stenosis (P=0.524), number of vessels with significant lesions (P=0.654), or number of interventions (P=0.536)) were statistically associated with major adverse cardiovascular events during the FU (mortality, AMI, need for revascularization). Figure 1 compares event-free survival by the Kalpan-Meyer method between patients that needed revascularization at index event and those who did not, and shows no difference on mean event-free survival (Log rank P=0.969). Conclusions: We conclude that revascularization at index event did not proved to change the prognosis of our sample during our FU period. This study highlights the low frequency of short-term adverse cardiovascular events in an UA sample and reinforces clinical decision-making regarding early discharge.