Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction.

Puelacher, Christian; Gugala, Mathias; Adamson, Philip D; Shah, Anoop; Chapman, Andrew R; Anand, Atul; Sabti, Zaid; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Wildi, Karin; Badertscher, Patrick; Rubini Gimenez, Maria; Shrestha, Samyut; Sazgary, Lorraine; Mueller, Deborah; Schumacher, Lukas; Kozhuharov, Nikola; Flores, Dayana; du Fay de Lavallaz, Jeanne; ... (2019). Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart (British Cardiac Society), 105(18), pp. 1423-1431. BMJ Publishing Group 10.1136/heartjnl-2018-314305

Full text not available from this repository. (Request a copy)

OBJECTIVE Assess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI). DESIGN Two independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year. RESULTS 8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0). CONCLUSIONS The relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-201X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

11 Dec 2019 07:30

Last Modified:

11 Dec 2019 07:30

Publisher DOI:

10.1136/heartjnl-2018-314305

PubMed ID:

31018955

Uncontrolled Keywords:

acute coronary syndrome mortality myocardial infarction unstable angina pectoris

URI:

https://boris.unibe.ch/id/eprint/134544

Actions (login required)

Edit item Edit item
Provide Feedback