title: Predictors of high-risk angiographic findings in patients with non-ST-segment elevation acute coronary syndrome.
abstract: BACKGROUND
  Current risk assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) may fail to identify some patients with severe coronary artery disease (CAD). We aimed to identify predictors of the angiographic extent and severity of CAD in patients with NSTE-ACS undergoing early angiography and to evaluate its impact on prognosis.
  
  
  METHODS
  We evaluated 923 patients with NSTE-ACS who underwent coronary angiography. High-risk coronary anatomy (HRCA) was defined as left main disease > 50%, proximal LAD lesion > 70%, or 2- to 3-vessel disease involving the LAD. Clinical characteristics, in-hospital, and 30-day outcome and 1-year mortality were compared between the high-risk (N = 370) and the low-risk groups (N = 553).
  
  
  RESULTS
  Proportion of patients with elevated cardiac biomarkers was similar in both groups. The presence of peripheral vascular disease (OR = 1.88, 95% confidence interval [CI] = 1.62-5.80, P < 0.001) and a GRACE score of >140 (OR = 1.88, 95% CI = 1.29-2.75, P < 0.001) were the strongest predictors of HRCA. Patients with HRCA were prone to more complications during hospitalization and at 30 days (11.9% vs. 6%, P < 0.01) and increased 1-year mortality (6.7% vs. 0.9%, P < 0.001). HRCA was the strongest predictor for 30-day MACCE (OR = 2.32, 95% CI = 1.42-3.79, P < 0.001). HRCA (OR = 8.36, 95% CI = 1.01-69.4, P = 0.049; OR = 3.64, 95% CI = 1.2-11.07, P = 0.02) and GRACE score of >140 (OR = 6.86, 95% CI = 1.68-27.9, P = 0.007; OR = 4.84, 95% CI = 1.74-13.5, P = 0.002) were significant predictors of 30-day and 1-year mortality, respectively.
  
  
  CONCLUSIONS
  HRCA is predicted by clinical parameters and was not associated with elevated cardiac biomarkers. These patients fared worse when compared with those with low-risk anatomy. We suggest that HRCA predictors should be included in the risk stratification of patients with NSTE-ACS.
authors.affiliation: The Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Natalie
authors.initials: N
authors.lastname: Gavrielov-Yusim
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: acute coronary syndrome; coronary anatomy; high risk; percutaneous coronary intervention; registry