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

Puelacher, Christian; Gugala, Mathias; Adamson, Philip D; Shah, Anoop; Anand, Atul; Sabti, Zaid; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Wildi, Karin; Badertscher, Patrick; Giménez, María Rubini; Shrestha, Samyut; Sazgary, Lorraine; Mueller, Deborah; Schumacher, Lukas; Kozhuharov, Nikola; Flores, Dayana; Lavallaz, Jeanne du Fay de; Miró, Òscar; Martín‐Sánchez, Francisco Javier; Morawiec, Beata; Fahrni, Gregor; Oßwald, Stefan; Reichlin, Tobias; Chapman, Andrew R.; Müeller, Christian

doi:10.1136/heartjnl-2018-314305

Cited by 49 publications

(42 citation statements)

References 21 publications

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“…The incidence of definite UA in our (complete) cohort was 5%. This is in line with recently published results by Puelacher et al, who investigated the incidence and outcomes of UA patients compared to NSTEMI patients in 8992 patients from the international APACE study and patients from a stepped wedge cluster RCT (4739 patients) which is still ongoing (HighSTEACS) [ 10 ]. However, wide ranges of incidence rates are reported, most likely as a consequence of an absent universal definition for UA [ 7 ].…”

Section: Discussionsupporting

confidence: 89%

“…However, recent studies show substantial differences between UA and NSTEMI patients with regards to incidence and mortality. Moreover, the non-existence of myocardial injury in UA patients even suggests differences in pathophysiology [ 10 ]. Several studies showed higher rates of future MI and coronary revascularisation in UA patients compared with non UA/non ACS patients [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the non-existence of myocardial injury in UA patients even suggests differences in pathophysiology [ 10 ]. Several studies showed higher rates of future MI and coronary revascularisation in UA patients compared with non UA/non ACS patients [ 10 – 12 ]. These findings emphasise the need for additional risk stratification to identify patients with low hsTn levels but true UA, since they have a non-neglectable risk of future adverse cardiovascular events [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

et al. 2020

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Background Despite the use of high-sensitive cardiac troponin there remains a group of high-sensitive cardiac troponin negative patients with unstable angina with a non-neglectable risk for future adverse cardiovascular events, emphasising the need for additional risk stratification. Plasma extracellular vesicles are small bilayer membrane vesicles known for their potential role as biomarker source. Their role in unstable angina remains unexplored. We investigate if extracellular vesicle proteins are associated with unstable angina in patients with chest pain and low high-sensitive cardiac troponin. Methods The MINERVA study included patients presenting with acute chest pain but no acute coronary syndrome. We performed an exploratory retrospective case-control analysis among 269 patients. Cases were defined as patients with low high-sensitive cardiac troponin and proven ischemia. Patients without ischemia were selected as controls. Blood samples were fractionated to analyse the EV proteins in three plasma-subfractions: TEX, HDL and LDL. Protein levels were quantified using electrochemiluminescence immunoassay. Results Lower levels of (adjusted) EV cystatin c in the TEX subfraction were associated with having unstable angina (OR 0.93 95% CI 0.88-0.99).

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

et al. 2020

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“…Japanese singlecentre study of 1233 patients found comparable late mortality and major adverse cardiac and cerebrovascular events between propensity matched ACS and stable CAD patients [9]. However, patients with MI have poorer prognosis than those with UA who are also included in ACS [21]. Despite the fact that patients who underwent CABG following unstable angina had better long-term survival than patients with NSTEMI, patients with unstable angina remain at high risk also after PCI when compared with stable CAD [22,23].…”

Section: Discussionmentioning

confidence: 99%

Outcome of acute myocardial infarction versus stable coronary artery disease patients treated with coronary bypass surgery

et al. 2020

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Objective: To study the long-term outcome differences between acute myocardial infarction (MI) and stable coronary artery disease (CAD) patients treated with coronary artery bypass grafting (CABG). Methods: We studied retrospectively patients with MI (n ¼ 1882) or stable CAD (n ¼ 13117) treated with isolated CABG between 2004 and 2014. Inverse propensity probability weight adjustment for baseline features was used. Median follow-up was 7.9 years. Results: In-hospital mortality (8.6% vs. 1.6%; OR 5.94; p < .0001) and re-sternotomy (5.5% vs. 2.7%; OR 2.07; p < .0001) were more common in MI patients compared to stable CAD patients. Hospital surviving MI patients had higher all-cause mortality (28.2% vs. 22.2%; HR 1.37; p ¼ .002) and MACE rate (34.4% vs. 27.4%; HR 1.22; CI 1.00-1.50; p ¼ .049) at 10-year follow-up. Cardiovascular mortality (15.9% vs. 12.7%; HR 1.36; p ¼ .017) and rate of new myocardial infarction (12.0% vs. 9.8%; HR 1.40; p ¼ .034) were also higher in MI patients during follow-up. In follow-up of stabilized first-year survivors, the difference in all-cause (26.5% vs. 20.7%; HR 1.40; p ¼ .003) and cardiovascular (14.2% vs. 11.4%; HR 1.37; p ¼ .027) mortality continued to increase between MI and stable CAD patients. Conclusion: MI patients have poorer short-and long-term outcomes compared to stable CAD patients after CABG and risk difference continues to increase with time. KEY MESSAGES 1. Patients with myocardial infarction have poorer short-and long-term outcomes compared to stable coronary artery disease patients after coronary artery bypass grafting (CABG). 2. Higher risk of death continues also in stabilized first-year myocardial infarct survivors. 3. The importance of efficient secondary prevention and follow-up highlights in post-myocardial infarct population after CABG.

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“…[27] In our study, we have found that there were more patients diagnosed as NSTEMI among patients with fQRS than among patients without. In a recently published study by (Puelacher et al, [28], assessed the relative incidence and compared the characteristics and outcome of unstable angina (UA) and NSTEMI. Despite their similar clinical presentations and treatment strategies, Puelacher and his colleagues have found that all-cause mortality was significantly higher in patients with NSTEMI compared with UA patients despite of similar incidence of future non-fatal myocardial infarction was comparable between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Radwan¹,

Mansour²,

Al-Daydamony³

et al. 2019

CCR

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Background: To detect the potential in hospital prognostic value of fQRS complex in patients with acute coronary syndrome (ACS) & investigate whether FQRS complex can be used to distinguish patients with early NSTEMI from those with unstable angina. Methods: It included 150 patients with acute NSTEMI and unstable angina. All patients were subjected to Grace score calculation, ECG to detect ischemic changes and detect presence or absent of fQRS, transthoracic echo to detect LV ejection fraction and recording in-hospital outcome. Results: Patients with fQRS have significant higher Killip class>2, higher troponin &CKMB levels, higher grace score, increased LVEDD & LVESD and significantly lower LVEF%. LVEF is significantly lower among patients with fQRS than patients with not fQRS in NSTEMI patients while there is no significant difference of LVEF % between both groups in unstable angina patients. There is significant association between fQRS and higher prevalence of NSTEMI and higher incidence of heart failure, arrhythmia and bad outcome. By multivariate analysis, NSTEMI (p =0.003) and high HR (p =0.004) and fragmented QRS (p =0.00) were the only significant predictors for bad outcome. FQRS have the ability to diagnose NSTEMI in 47.9% of cases, fQRs can truly exclude NSTEMI in 72.7% of case. Conclusion: Among patients with ACS, the presence of fQRS was associated with an increase incidence of complication, worse outcome, larger LV dimensions, and lower LVEF. The presence of fQRS in acute coronary syndrome patients could predict the presence of NSTEMI with fair diagnostic value.

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

Cited by 49 publications

References 21 publications

Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

Extracellular Vesicle cystatin c is associated with unstable angina in troponin negative patients with acute chest pain

Outcome of acute myocardial infarction versus stable coronary artery disease patients treated with coronary bypass surgery

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

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