Predictors of multi-vessel coronary artery disease in patients presenting with NSTEMI / Unstable angina: Possible tool to decrease in-hospital morbidity

Elrod, Jacob

Predictors of multi-vessel coronary artery disease in patients presenting with NSTEMI / Unstable angina: Possible tool to decrease in-hospital morbidity

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Jacob Elrod, MD , University of Alabama at Birmingham, Birmingham, AL

Jared Davis , University of Alabama at Birmingham, Birmingham, AL

Amrita Mukherjee, BDS, MPH , University of Alabama at Birmingham, Birmingham, AL

Jeremy S White, MD , University of Alabama at Birmingham, Birmingham, AL

Vedran Oruc, MD , University of Alabama at Birmingham, Birmingham, AL

Chad Colon, MD , University of Alabama at Birmingham, Birmingham, AL

Zachary Doegg, MD , University of Alabama at Birmingham, Birmingham, AL

Firas Al Solaiman, M.D. , University of Alabama at Birmingham, Birmingham, AL

Samuel K McElwee, MD , University of Alabama at Birmingham, Birmingham, AL

Arka Chatterjee, M.D., FSCAI , University of Alabama at Birmingham, Birmingham, AL

Background
Dual antiplatelet therapy (DAPT) prior to coronary angiography (CAG) is standard of care for Non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients. However, patients with surgical CAD who receive DAPT have delays in CABG or have increased risks of bleeding if operated. Identifying surgical CAD by clinical / imaging features may help avoid DAPT and facilitate earlier / safer CABG.

Methods
Consecutive patients who underwent CAG for NSTEMI or UA where included. Chart review was done to extract demographic, clinical, imaging, and angiographic data. Surgical CAD was defined as Left main stenosis ≥ 50% and/ or stenosis ≥ 70% of Left anterior descending artery and one other major epicardial coronary artery. Risk factors for surgical CAD were identified using univariate analysis and then further refined with stepwise multivariable logistic regression.

Results
A total of 1221 patients were included in the study [median age 61 (18) years; 64.6% male, 65.6% Caucasian, 41.4% DM, 69.9% with NSTEMI, 30.1% with UA, median EF 55% (15)]. 33.1% of patients (n=405) had surgical CAD. Independent risk factors for surgical CAD were increasing age, DM, ST changes in ≥ 2 leads and lower EF. Odds of having surgical disease were decreased in patients with a prior PCI (Figure).

Conclusions
Simple clinical / echo features are significantly associated with surgical CAD in NSTEMI / UA patients. Risk factors identified need to be validated in larger registry populations and may lead to formulation of a simple risk stratification tool to select patients in whom DAPT pre-loading may cause CABG delay / increased CABG bleeding, thus affecting patient morbidity.