Key result
In patients with low-risk unstable angina, an ischemic response in functional stress tests independently predicted adverse events at 6 months (OR 6.4).
Why the study?
Does a positive ischemic response in functional imaging tests (SPECT or stress echocardiography) predict adverse events in low-risk unstable angina patients?
Cohort (n=359)
No
Does a positive ischemic response in functional imaging tests (SPECT or stress echocardiography) predict adverse events in low-risk unstable angina patients?
Odds Ratio: 6.4 (95% CI 3.4–11.8)
p-value: p=<0.0001
In low-risk unstable angina patients, an ischemic response on SPECT or stress echocardiography strongly predicts 6-month adverse events and severe coronary artery disease.
May support risk stratification in low-risk unstable angina; leaves open whether positive tests should guide management pending randomized data.
BACKGROUND: The aim of this study is to determine the ability of ischemic response in imaging stress tests (single-photon emission computed tomography [SPECT] or stress echocardiography [SE]) to predict events in low-risk unstable angina patients. METHODS: Three hundred and fifty-nine patients with unstable angina (< 24 h), asymptomatic at admission, without ST-segment elevation or depression, normal troponins, and undergoing SPECT (n = 188) or SE (n = 171) during hospitalization (median = 1 day) were included. A positive imaging test (IMAGING+) was defined as the presence of reversible perfusion defects or wall motion abnormalities in at least 2 contiguous segments. Multivariate models were constructed using these results and clinical variables to predict events at 6 months. RESULTS: Ninety-nine (27%) patients had IMAGING+, 72/188 (38%) in SPECT and 27/17 (16%) in SE (p < 0.0001). Events occurred in 84 (23%) patients: 4 had myocardial infarction, 47 new hospitalizations due to angina and 33 coronary artery revascularizations. Independent predictors of coronary artery disease were: IMAGING+ (OR: 6.4, 95% CI: 3.4-11.8, p < 0.0001), history of coronary artery disease (OR: 2.5, 95% CI: 1.2-5.2, p < 0.02) and TIMI risk (OR: 1.5, 95% CI: 1.1-2.2, p < 0.03). CONCLUSIONS: In low-risk unstable angina patients, an ischemic response in functional stress tests (SPECT or SE) was associated with adverse events and severe coronary artery disease.
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Trivi et al. (2014) conducted a cohort in Low-risk unstable angina (n=359). Ischemic response in functional imaging tests (SPECT or stress echocardiography) vs. No ischemic response (negative imaging test) was evaluated on Adverse events at 6 months (myocardial infarction, new hospitalizations due to angina, and coronary artery revascularizations) (OR 6.4, 95% CI 3.4-11.8, p=<0.0001). In patients with low-risk unstable angina, an ischemic response in functional stress tests independently predicted adverse events at 6 months (OR 6.4).
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