ArticleClinical research in cardiology : official journal of the German Cardiac Society2020
Management and outcomes of patients with unstable angina with undetectable, normal, or intermediate hsTnT levels.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03111862 (Observational Study on the Safety of Accelerated Rule-out Protocols in Patients Admitted With Chest Pain to a Crowded CPU), which is not on this map. Cited by 12 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Observational Study on the Safety of Accelerated Rule-out Protocols in Patients Admitted With Chest Pain to a Crowded CPU
Who cites it
12 citing papers in PubMed, 26 citations in OpenAlex.
- The effect of combined rhythmic breathing and aromatherapy on pain intensity and anxiety in patients with unstable angina.Contemporary clinical trials communications · 2025Article
- Incidence and 1-Year Prognostic of Unstable Angina After High-Sensitivity Troponin Assessment.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025Observational
- Resolving the observe zone: validation of the ESC 0/3-hour and the APACE criteria for NSTEMI triage.Open heart · 2025Observational
- Predictors of Revascularization in Patients with Unstable Angina.Journal of clinical medicine · 2024Article
- Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in The Era of High-Sensitivity Cardiac Troponin.Global heart · 2024Article
- The Predictive Power of the 14-51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting.Journal of clinical medicine · 2022Article
- Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population.International journal of cardiology. Heart & vasculature · 2022Article
- Unstable Angina as a Component of Primary Composite Endpoints in Clinical Cardiovascular Trials: Pros and Cons.Cardiology · 2022Review
- High-sensitivity cardiac troponin T determines all-cause mortality in cancer patients: a single-centre cohort study.ESC heart failure · 2021Article
- Biomarkers for infarct diagnosis and rapid rule-out/rule-in of acute myocardial infarction.Herz · 2020Review
- Investigating the multi-target pharmacological mechanism of danhong injection acting on unstable angina by combined network pharmacology and molecular docking.BMC complementary medicine and therapies · 2020Article
- Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain.PloS one · 2020Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients with unstable angina (UA) are regarded to be at low risk for future coronary events. Guidelines discourage routine coronary angiography and recommend early discharge after individualized risk stratification. The relative value of clinical risk indicators as compared to cardiac troponin (cTn) alone is unsettled in the era of high-sensitivity cardiac troponin (hsTn) assays. We aimed to investigate the clinical characteristics, therapies, and outcomes of UA patients with different hsTnT concentrations.
methodsDuring 12 months, 2525 patients were enrolled. UA was defined as unstable symptoms and either undetectable (< 5 ng/L), normal (5-14 ng/L) or stable elevated hsTnT (15-51 ng/L). Follow-up for 1-year mortality was available in 98.7%.
resultsA total of 280 patients (11.1%) received a diagnosis of UA. Mortality rates at 12 months were 0%, 1.9% and 6.9% in presence of undetectable, normal and stable elevated hsTnT. Elevated hsTnT > 99th percentile but not unstable symptoms carried an independent 3.25-fold (1.78-5.93) higher risk for all-cause death after adjustment for other clinical risk indicators or the GRACE score. Utilization of guideline-recommended therapies was high albeit lower than for non-ST-elevation myocardial infarction (NSTEMI). Significantly fewer patients with UA received dual antiplatelet therapy (DAPT, odds ratio (OR) 0.51 [95% CI 0.44-0.59], P < 0.0001), coronary angiography (CA, OR 0.79, [95% CI 0.74-0.87], P < 0.0001), and percutaneous coronary intervention (PCI, OR 0.50, [95% CI 0.40-0.61], P < 0.0001), compared to NSTEMI. However, prevalence of significant obstructive coronary artery disease requiring PCI was 31.8%, even in patients with undetectable hsTnT, indicating the need for stress testing.
conclusionsThe current dichotomization of patients into UA and NSTEMI is no longer appropriate. Additional risk stratification seems warranted including the presence and magnitude of hsTn concentration and additional risk indicators. Clinical Trials Identifier: NCT03111862.
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