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). Objectives: 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 Rapid Acute Coronary Syndrome Exclusion using high-sensitivity cardiac Troponin I (RACE-IT) trial was conducted. RACE-IT was a stepped-wedge randomized trial comparing two rule-out protocols (0/1- and 0/3 h) 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 99th 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 whom 46 (77%) had obstructive disease at coronary angiography and 17 (28%) had an ischemic electrocardiogram. Coronary revascularization was performed in 45 (75%) patients and seven (12%) had left main or 3-vessel coronary artery disease. There were seven (12%) patients with non-obstructive coronary artery disease, and seven (12%) who had angiographically unremarkable coronary arteries. Patients with unstable angina were older (p = 0.015),…
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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