Key result
Medium-to-high risk Duke Treadmill Score linked to ~56% higher 10-year major cardiovascular events risk in atypical chest pain.
Why the study?
Longstanding cardiovascular risk factors cause MACE, and predicting MACE may improve outcomes in patients without angina.
Do baseline clinical risk factors and noninvasive ischaemia screening tests (Duke Treadmill Score, echocardiography score, and sestaMIBI myocardial perfusion ischaemic burden) predict 10-year MACE morbidity and mortality in patients presenting without typical angina?
Cohort (n=525)
No
Do baseline clinical risk factors and noninvasive ischaemia screening tests (Duke Treadmill Score, echocardiography score, and sestaMIBI myocardial perfusion ischaemic burden) predict 10-year MACE morbidity and mortality in patients presenting without typical angina?
Answers are grounded in this paper and cite their sources.
In South African patients presenting without typical angina, baseline diabetes and noninvasive evidence of ischaemia on exercise stress testing, echocardiography, and sestaMIBI perfusion imaging independently predict 10-year MACE morbidity and mortality.
BACKGROUND: Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina. METHODS: Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality. RESULTS: There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780). CONCLUSION: Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality.Contribution: Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.
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Premsagar et al. (2023) conducted a cohort in Suspected coronary artery disease without typical angina (n=525). Medium-to-high Duke Treadmill Score risk category vs. Low risk category on Duke Treadmill Score was evaluated on 10-year major adverse cardiovascular events (MACE) morbidity (HR 1.563, 95% CI 1.076-2.268, p=0.019). Medium-to-high risk on the Duke Treadmill Score, myocardial perfusion ischaemic burden, diabetes, and age predicted 10-year major cardiovascular events morbidity in patients without typical angina.
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