Angiography for Managing Unstable Angina

Jun 21, 2017
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Authors:
Vogrin S, Harper R, Paratz E, et al.
Citation:
Comparative Effectiveness of Routine Invasive Coronary Angiography for Managing Unstable Angina. Ann Intern Med 2017;166:783-791.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of an invasive approach on outcome of patients with unstable angina?

Methods:

The authors assessed the outcome of all patients (n = 33,901) who were admitted to any hospital in the state of Victoria, Australia between 2001 and 2011. Propensity score adjustment was used to account for the nonrandom use of angiography.

Results:

Routine angiography was associated with a significantly lower 12-month mortality (hazard ratio, 0.48; 95% confidence interval, 0.38-0.61). The 6-month mortality in this cohort was 4.19% and increased at 1 year to 6.28%. The predicted cumulative incidence of death at 1 year was 2.4% for patients who received angiography at index admission, and 9.7% for those who did not receive angiography within the study period. The findings were robust to the presence of unmeasured confounder.

Conclusions:

The authors concluded that patients with unstable angina benefit from an invasive approach with an early survival benefit.

Perspective:

This study corroborates current guidelines that support invasive management of unstable angina. The biggest challenge with unstable angina is that it remains a clinical diagnosis, and while a large proportion of patients with unstable angina have significant coronary artery disease, an equally large proportion has nonobstructive disease. Further research is needed to define better methods for optimal risk stratification in this population.

Keywords: Angina, Unstable, Coronary Angiography, Coronary Artery Disease, Mortality, Risk, Treatment Outcome


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