Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population

Kristina Fladseth; Tom Wilsgaard; Haakon Lindekleiv; Andreas Kristensen; Jan Mannsverk; Maja-Lisa Løchen; Inger Njølstad; Ellisiv B Mathiesen; Thor Trovik; Svein Rotevatn; Signe Forsdahl; Henrik Schirmer

doi:10.1016/j.ijcha.2022.101099

Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population

Int J Cardiol Heart Vasc. 2022 Jul 31:42:101099. doi: 10.1016/j.ijcha.2022.101099. eCollection 2022 Oct.

Authors

Kristina Fladseth^{1

2}, Tom Wilsgaard³, Haakon Lindekleiv², Andreas Kristensen², Jan Mannsverk², Maja-Lisa Løchen³, Inger Njølstad³, Ellisiv B Mathiesen^{1

4}, Thor Trovik², Svein Rotevatn^{5

6}, Signe Forsdahl⁷, Henrik Schirmer^{1

8

9}

Affiliations

¹ Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
² Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
³ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴ Department of Neurology, University Hospital of North Norway, Tromsø, Norway.
⁵ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
⁶ Norwegian Registry of Invasive Cardiology, Bergen, Norway.
⁷ Department of Radiology, University Hospital North Norway, Tromsø, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway.
⁹ Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.

Abstract

Background: The outcomes of real-world unstable angina (UA) in the high-sensitivity troponin era are unclear. We aimed to investigate the outcomes of UA referred to coronary angiography compared to stable angina (SA), non-ST-segment elevation myocardial infarction (NSTEMI), STEMI and a general population.

Methods: We included the 9,694 patients with no prior coronary artery disease (CAD) referred to invasive or CT coronary angiography from 2013 to 2018 in Northern Norway (51% SA, 12% UA, 23% NSTEMI and 14% STEMI), and 11,959 asymptomatic individuals recruited from the Tromsø Study. We used Cox models to estimate the hazard ratios (HR) for all-cause mortality and major adverse cardiovascular events (MACE), defined as cardiovascular death, MI or obstructive CAD.

Results: The median follow-up time was 2.8 years. The incidence rate of death was 8.5 per 1000 person-years (95 % confidence interval [CI] 8.0-9.0) in the general population, 9.7 (95 % CI 8.3-11.5) in SA, 14.9 (95 % CI 11.4-19.6) in UA, 29.7 (95 % CI 25.6-34.3) in NSTEMI and 36.5 (95 % CI 30.9-43.2) in STEMI. In multivariable adjusted analyses, compared with UA, SA had a 38 % lower risk of death and a non-significant lower risk of MACE (HR 0.62, 95 % CI 0.44-0.89; HR 0.86, 95 % CI 0.66-1.11). NSTEMI had a 2.4-fold higher risk of death (HR 2.39, 95 % CI 1.38-4.14) and a 1.6-fold higher risk of MACE (HR 1.62, 95 % CI 1.11-2.38) compared tox UA during the first year after coronary angiography, but a similar risk thereafter. There was no difference in the risk of death for UA with non-obstructive CAD and obstructive CAD (HR 0.78, 95 % CI 0.39-1.57).

Conclusion: UA had a higher risk of death but a similar risk of MACE compared to SA and a lower 1-year risk of death and MACE compared to NSTEMI.

Keywords: CABG, Coronary artery bypass graft; CAD, Coronary artery disease; CCTA, Coronary computed tomography angiography; ESC, European Society of Cardiology; FFR, Fractional flow reserve; High-sensitivity troponins; Hs-cTn, High-sensitivity troponin; ICA, Invasive coronary angiography; MACE, Major cardiovascular events; MI, Myocardial infarction; NORIC, Norwegian Registry of Invasive Cardiology; NSTE-ACS, Non-ST-segment elevation acute coronary syndrome; NSTEMI, Non-ST-segment elevation myocardial infarction; Non-ST elevation acute coronary syndrome; Non-obstructive coronary artery disease; PCI, Percutaneous coronary intervention; Prognosis; SA, Stable angina; STEMI, ST-segment elevation myocardial infarction; UA, Unstable angina.