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Minerva Cardioangiologica 2019 June;67(3):181-90

DOI: 10.23736/S0026-4725.19.04838-2


lingua: Inglese

Baseline indicators of coronary artery disease burden in patients with non-ST-segment elevation acute coronary syndrome

Konrad STEPIEN , Karol NOWAK, Pawel SKOREK, Veranika BARAVIK, Anna KOZYNACKA, Jadwiga NESSLER, Jaroslaw ZALEWSKI

Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland

BACKGROUND: We sought to investigate whether baseline characteristics of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) may predict their coronary artery disease (CAD) burden.
METHODS: Baseline clinical, ECG and laboratory data were compared with angiographic findings of 693 consecutive NSTEACS patients. According to the angiography result all patients were assigned to one of the three groups with: significant stenosis of left main and/or three-vessel CAD (LM-3VD, N.=114), single- or two-vessel CAD (1-2VD, N.=335) or without significant CAD (noVD, N.=244).
RESULTS: Baseline characteristics of compared groups were different. By multivariable logistic regression necrotic enzyme negative ACS (odds ratio [OR] 5.57, 95% CI: 3.74-8.29), female gender (OR=2.23, 95% CI: 1.54-3.24), no previous myocardial infarction (OR=2.06, 95% CI: 1.38-3.08), no diabetes mellitus (OR=1.53, 95% CI: 1.04-2.25), no peripheral arterial disease (OR=1.77, 95% CI: 1.05-2.99) and hematocrit level (0.95 per 1%, 0.91-0.99) independently predicted noVD (χ2=145.8, P<0.0001) with c-statistics of 0.80. All independent predictors were ranked according to the results of multivariable model and the new score for prediction of noVD was introduced with the area under the ROC curve of 0.77 (95% CI: 0.73-0.80, P<0.0001) and sensitivity of 70% and specificity of 66% for <5 points. Also, independent predictors of LM-3VD (age, male gender, diabetes mellitus, peripheral arterial disease, necrotic enzyme positive ACS and baseline Killip Class 3/4) were determined, however their predictive accuracy was moderate with the area under the ROC curve of 0.69 (95% CI: 0.64-0.75).
CONCLUSIONS: In patients with NSTEACS, baseline characteristics are useful in predicting a lack of significant CAD, whereas their correlations with multivessel CAD remain moderate.

KEY WORDS: Acute coronary syndrome - Coronary artery disease - Risk factors - Electrocardiography - Biomarkers

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