Incidence and outcomes of unstable angina in patients with low high-sensitivity cardiac troponin I values – A substudy of the RACE-IT trial
Abstract
Background: Unstable angina has become an exceedingly rare diagnosis in the era of high-sensitivity cardiac troponin (hs-cTn). We sought to identify the incidence of unstable angina and characterize patients with low hs-cTn in Emergency Departments (EDs).
Methods: A prespecified secondary analysis of the R apid A cute C oronary Syndrome E xclusion using high-sensitivity I cardiac T roponin (RACE-IT) trial was conducted. RACE-IT was a stepped-wedge randomized trial comparing two rule-out protocols (0/1- and 0/3-hour) for myocardial infarction (MI) in nine EDs from July 2020 to April 2021. All patients had hs-cTnI (Beckman Coulter) concentrations below or equal to the 99 th percentile upper reference limit of 18 ng/L. The primary outcome was unstable angina, based on the ISCHEMIA trial definition, which required electrocardiographic changes or findings at coronary angiography (angiographic evidence of plaque rupture or thrombus).
Results: Of the 32,608 patients in the trial, 60 patients (0.2%) met the definition of unstable angina of which 46 (77%) had obstructive disease at coronary angiography and 17 (28%) had an ischemic electrocardiogram. Coronary revascularization was performed in 45 (75%) patients and 7 (12%) had left main or 3-vessel coronary artery disease. There were 7 (12%) patients with non-obstructive coronary artery disease, and 7 (12%) who had angiographically unremarkable coronary arteries. Patients with unstable angina were older (p=0.032), more likely to be…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 32,608 participants or records.
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