title: Predictors of complicated athero-thrombotic lesions in non-ST segment acute coronary syndrome.
abstract: OBJECTIVE
  Non-ST segment elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous syndrome in terms of patho-physiological mechanisms and prognosis. We sought to investigate the clinical features associated with complicated athero-thrombotic (CAT) coronary lesions and their prognostic relevance in NSTE-ACS.
  
  
  METHODS
  We enrolled 701 consecutive NSTE-ACS patients without previous coronary bypass undergoing coronary angiography. The study population was divided into two groups according to the presence/absence of angiographic signs of endoluminal thrombi and/or plaque rupture, defined as CAT lesions. Multivariable analyses were used to identify predictors of CAT lesions. Their relation to composite endpoint of death, re-myocardial infarction, and re-unstable angina was investigated with the use of multivariable logistic regression.
  
  
  RESULTS
  Patients with CAT lesions (n = 279, 40%) had a higher incidence of the combined endpoint (11.5 vs. 4.3%; P < 0.001). On multivariable analysis male sex [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.17-2.30, P = 0.004], previous percutaneous coronary intervention (PCI) (OR 0.48, 95% CI 0.32-0.72, P < 0.001), severe angina (OR 1.72, 95% CI 1.18-2.52, P = 0.005) and anterior (i.e. V1-V4) ST segment depression (STD) were independently associated with CAT lesions (OR 1.71, 95% CI 1.14-2.57, P = 0.01). After adjustment for the Global Registry of Acute Coronary Events (GRACE) score only the presence of anterior STD emerged as an independent predictor of the clinical endpoint (OR 2.68, 95% CI 1.38-5.20, P = 0.003). The incorporation of anterior STD into the GRACE risk score showed an important trend toward improving prediction of endpoint as assessed by c-statistic (0.72 vs. 0.67; P = 0.08).
  
  
  CONCLUSIONS
  In patients with NSTE-ACS male sex, severe angina and anterior STD were associated with an increased risk of CAT lesions. Patients with anterior STD were also at increased risk of in-hospital clinical events.
authors: Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna, Italy. neviotaglieri@hotmail.it
authors: Nevio
authors: N
authors: Taglieri
authors: Gianni
authors: G
authors: Dall'Ara
authors: Claudio
authors: C
authors: Rapezzi
authors: Francesco
authors: F
authors: Saia
authors: Laura
authors: L
authors: Cinti
authors: Stefania
authors: S
authors: Rosmini
authors: Laura
authors: L
authors: Alessi
authors: Fabio
authors: F
authors: Vagnarelli
authors: Carolina
authors: C
authors: Moretti
authors: Tullio
authors: T
authors: Palmerini
authors: Cinzia
authors: C
authors: Marrozzini
authors: Michela
authors: M
authors: Montefiori
authors: Angelo
authors: A
authors: Branzi
authors: Antonio
authors: A
authors: Marzocchi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D003328:Coronary Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous