Jouen Romain, Meunier Pierre-Alain, Moulis Lionel, Roubille Francois, Macia Jean-Christophe, Berdeu Jean-Michel, Steinecker Matthieu, Robert Pierre, Lattuca Benoit, Cayla Guillaume, Leclercq Florence
Department of Cardiology, University of Montpellier, Montpellier, France.
Department of Epidemiology, University of Montpellier, Montpellier, France.
Catheter Cardiovasc Interv. 2025 May;105(6):1445-1452. doi: 10.1002/ccd.31473. Epub 2025 Mar 6.
Incidence and prognostic of unstable angina after high-sensitivity troponin assesment is controversial.
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).
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.
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.
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).
高敏肌钙蛋白评估后不稳定型心绞痛的发病率及预后存在争议。
本研究评估了使用高敏肌钙蛋白T（T hs-cTn）测量定义的当代不稳定型心绞痛患者群体以及患有严重冠状动脉疾病（CAD）患者的预后。
纳入在2家法国大学中心连续收治的不稳定型心绞痛患者，其定义为临床缺血症状且T hs-cTn检测不到（<5 ng/L）、未升高（>14 ng/L）或轻度升高（14 - 50 ng/L）。主要终点包括1年随访时的主要事件。
在2021年12月至2023年2月因急性冠状动脉综合征（ACS）入院的1752例患者中，210例（12.0%）患有不稳定型心绞痛和严重CAD。平均年龄为66±12岁，男性居多（n = 143；68.1%）。患者的T hs-cTn检测不到（n = 4）、未升高（n = 80）或轻度升高且稳定（n = 126）。98例患者（46.6%）有CAD病史。主要患者（n = 186；88.6%）需要进行经皮介入治疗。1例患者发生了不良非致命性院内事件。55例患者（26.2%；95%置信区间[20.2 - 32.1]）达到主要结局，主要与新发ACS（n = 34，16.2%）有关。入院时肌钙蛋白水平（p = 0.639）与主要结局无关。在多变量分析中，多种风险因素（比值比1.93，[1.01 - 3.69]，p = 0.0194）、CAD病史（3.09；置信区间[1.63；5.87]，p = 0.0005）和三尖瓣疾病（比值比2.66；置信区间[1.24；5.69]，p = 0.0118）与1年时的主要事件显著相关。
当代伴有严重CAD的不稳定型心绞痛发病率较低，院内事件较少，但心脏事件1年发病率较高（26%），主要与新发ACS有关。改善二级预防对这些患者可能至关重要。（标识符：NCT06378333）
