Prospective registry of non-ST-elevation acute coronary syndrome in a regional vascular center (CONTRAST). Study design and outcomes of the hospital stage

Aim. To evaluate the real-world practice of diagnosing non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) in patients admitted with a diagnosis of non-ST-elevation acute coronary syndrome (NSTE-ACS) to a regional vascular center of one of the Moscow region cities.

Material and methods. The prospective registry of NSTE-ACS in a regional vascular center (CONTRAST) included all patients consistently admitted with a diagnosis of NSTE-ACS from October 2018 to March 2019. Upon admission, all patients underwent coronary angiography (CAG). Percutaneous coronary intervention (PCI) was considered depending on the CAG data, as well as the clinical condition of the patients, electrocardiographic and medical history data. At the time of CAG and the decision for PCI, the blood troponin levels were unknown.

Results. The study included 136 patients, of whom 83 (61%) were men. The mean age of patients was 63,8±10,9 years, ranging from 38 to 93 years. At hospital discharge, UA was diagnosed in 112 (82,4%) patients and NSTEMI — in 24 (17,6%). UA was more common in female patients than NSTEMI — 40,2 vs 33% (p>0,05). NSTEMI, on the contrary, was more common in males — 66,7 vs 59,8% (p>0,05). Patients with NSTEMI were older than patients with UA — 69 years vs 63 years (p=0,011). Patients with NSTEMI were significantly more likely to have a prior MI — 58 vs 32% (p=0,029). According to angiographic data, patients with NSTEMI demonstrated a higher prevalence of multivessel coronary artery disease — 50 vs 26,8% (p=0,041). Predominantly in patients with NSTEMI, an increase in the troponin I level was observed — 83 vs 50% (p=0,011). In patients with UA, emergency PCI was performed significantly less frequently compared to patients with NSTEMI — 28 vs 67% (p=0,001). When prescribing dual antiplatelet therapy in a hospital, ticagrelor was preferred as the second drug in patients with NSTEMI — 50 vs 10% (p<0,001), while in patients with UA, on the contrary, clopidogrel was used more often — 84 vs 50% (p<0,001).

Conclusion. The results suggest that when making a definitive diagnosis, doctors were more focused on the medical history, the clinical condition of patients, ECG and echocardiography abnormalities, and the severity of CAG changes. Data on cardiac specific troponin levels were less often considered.

1. Braunwald E, Antman EM, Beasley JW, Al E. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Manage. J Am Coll Cardiol. 2000;36:970-1062. Erratum in: J Am Coll Cardiol. 2001. doi:10.1016/s0735-1097(00)00889-5.

2. Bugiardini R. Risk stratification in acute coronary syndrome: focus on unstable angina/non-ST segment elevation myocardial infarction. Heart. 2004;90:729-31. doi:10.1136/hrt.2004.034546.

3. Apple FS, Jaffe AS, Collinson P, et al. International Federation of Clinical Chemistry (IFCC) Task Force on Clinical Applications of Cardiac Bio-Markers. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem. 2015;48:201-3. doi:10.1016/j.clinbiochem.2014.08.021.

4. Wilson SR, Sabatine MS, Braunwald E, et al. Detection of myocardial injury in patients with unstable angina using a novel nanoparticle cardiac troponin I assay: observations from the PROTECT-TIMI 30 Trial. Am Hear J. 2009;158:386-91. doi:10.1016/j.ahj.2009.06.011.

5. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation. 2013;127:2452-7. doi:10.1161/CIRCULATIONAHA.113.001258.

6. Eggers KM, Jernberg T, Lindahl B. Unstable Angina in the Era of Car­diac Troponin Assays with Improved Sensitivity-A Clinical Di­lem­ma. Am J Med. 2017;130:1423-30.e5. doi:10.1016/j.amjmed.2017.05.037.

7. Urvantseva IA, Salamatina LV, Milovanova EV, et al. Regional Experience of Conducting Registry of Acute Coronary Syndrome. Kardiologiia. 2013;(8):11-4. (In Russ.)

8. Erlikh AD, Gratsiansky NA, on behalf of participants RECORD-3 registers. Registry of acute coronary syndromes "RECORD-3". Characteristics of patients and treatment until discharge during initial hospitalization. Kardiologiia. 2016;56(4):16-24. (In Russ.) doi:10.18565/cardio.2016.4.16-24.

9. Nesova AK, Tsydypova DB, Ryabov VV. Clinical profile of patients with non-ST segment elevation acute coronary syndrome: expe­rience of a regional vascular center. Cardiovascular Therapy and Prevention. 2024;23(8):3994. (In Russ.) doi:10.15829/1728-8800-2024-3994.

10. Piątek Ł, Janion-Sadowska A, Piątek K, et al. Long-term clinical outcomes in patients with unstable angina undergoing percutaneous coronary interventions in a contemporary registry data from Poland. Coron Artery Dis. 2020; 31:215-21. doi:10.1097/MCA.0000000000000812.

11. Sagaydak OV, Oshchepkova EV, Popova YuV, et al. Treatment of patients with acute coronary syndrome in 2019 (data from federal registry of acute coronary syndrome). Kardiologicheskii Vestnik. 2020;3:37-45. (In Russ.) doi:10.36396/MS.2020.16.3.005.

12. Li SY, Zhou MG, Ye T. Frequency of ST-segment elevation myo­car­dial infarction, non-ST-segment myocardial infarction, and unstable angina: Results from a Southwest Chinese Registry. Rev Cardiovasc Med. 2021;22:239-45. doi:10.31083/j.rcm.2021.01.103.

13. Damman P, Van Geloven N, Wallentin L, et al. Timing of angiogra­phy with a routine invasive strategy and long-term outcomes in NonST-segment elevation acute coronary syndrome. JACC Cardiovasc Interv. 2012;5:191-9. doi:10.1016/j.jcin.2011.10.016.

14. Boytsov SA, Shakhnovich RM, Erlikh AD, et al. Registry of Acute Myocardial Infarction. REGION-MI — Russian Registry of Acute Myocardial Infarction. Kardiologiia. 2021;61(6):41-51. (In Russ.) doi:10.18087/cardio.2021.6.n1595.

15. Gridnev VI, Kiselev AR, Posnenkova OM, et al. Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR). Clin Cardiol. 2016;39:1-8. doi:10.1002/clc.22495.

16. Martsevich SYu, Lukina YuV, Kutishenko NP, et al. Medical registers. Role in evidence-based medicine. Guidelines for creation. Methodological guidelines. M.: ROPNIZ, Silicea-Poligraf. 2023. 44 p. (In Russ.) doi:10.15829/ROPNIZ-m1-2023.