Fladseth Kristina, Kristensen Andreas, Mannsverk Jan, Trovik Thor, Schirmer Henrik
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway.
Open Heart. 2018 Nov 1;5(2):e000888. doi: 10.1136/openhrt-2018-000888. eCollection 2018.
Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.
From 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.
The overall rate of obstructive CAD was 45%, and the rate of prognostically significant CAD was 11%. The risk criteria recommended in American College of Cardiology/American Heart Association and European Society of Cardiology guidelines had an area under the curve (AUC) of 0.58. Adding clinical information increased the AUC to 0.77 (95% CI 0.74 to 0.80). Applying the derived score, we found that 56% (n=546) of patients had a score of <13, which was associated with a negative predictive value of 95% for prognostic significant CAD.
The current results suggest that CAG may be postponed or cancelled in more than half of patients with UA by improving pre-test selection criteria with the addition of clinical parameters to current guidelines.
因不稳定型心绞痛（UA）接受急性冠状动脉造影（CAG）的患者死亡率低，阻塞性冠状动脉疾病（CAD）发生率也低。因此需要更好的检查前选择标准。我们旨在评估当前指南与其他临床变量作为因UA接受急性CAG患者阻塞性CAD预测指标的比较。
2005年至2012年期间，挪威北部大学医院（该地区唯一提供CAG的机构）进行的所有CAG均记录在一个登记册中。我们纳入了979例UA患者，并从患者医院记录中回顾性收集了有关呈现的临床参数的数据。阻塞性CAD定义为狭窄≥50%，如果在左主干、近端LAD或所有三支主要冠状动脉中发现，则被认为具有预后意义。通过逻辑回归分析对特征进行分析。使用多变量模型中显著因素的比值比（OR）制定了一个评分。
阻塞性CAD的总体发生率为45%，具有预后意义的CAD发生率为11%。美国心脏病学会/美国心脏协会和欧洲心脏病学会指南推荐的风险标准曲线下面积（AUC）为0.58。添加临床信息后，AUC增加到0.77（95%CI 0.74至0.80）。应用得出的评分，我们发现56%（n = 546）的患者评分<13，这与具有预后意义的CAD的阴性预测值95%相关。
目前的结果表明，通过在当前指南中添加临床参数来改善检查前选择标准，超过一半的UA患者可能会推迟或取消CAG。
