Ten year mortality in subsets of patients with an acute coronary syndrome

Abstract

Objective-To describe the mortality during the subsequent 10 years for subsets of patients hospitalised for suspected acute coronary syndrome. Patients and methods-All patients who were admitted to the emergency department in one hospital during 21 months for chest pain or other symptoms raising suspicion of an acute coronary syndrome were registered. From this baseline population three subgroups were defined among those being hospitalised: patients who developed a Q wave acute myocardial infarction (AMI) (n = 306); patients who developed a non-Q wave AMI (n = 527); and patients who developed confirmed or possible myocardial ischaemia (unstable angina pectoris) (n = 1274). These three groups were compared in terms of 10 year mortality. Results-Patients who developed a non-Q wave AMI had the highest 10 year mortality (70.3%), significantly higher than those who developed a Q wave AMI (60.1%; p = 0.004) and those who had confirmed or possible myocardial ischaemia (50.1%; p < 0.0001). There was no diVerence between patients with confirmed and those with possible myocardial ischaemia (50.0% and 50.1%, respectively). After correction for dissimilarities in age, sex, and history the adjusted risk ratio for death in patients with a non-Q wave AMI compared with Q wave AMI was 1.01 (95% confidence interval (CI) 0.82 to 1.25). The corresponding risk ratio for death in patients with a non-Q wave AMI compared with confirmed or possible myocardial ischaemia was 1.91 (95% CI 1.64 to 2.23). There was also an imbalance in drug regimens among groups. Conclusion-This study shows that in a non-selected population of patients hospitalised with a suspected acute coronary syndrome, the highest risk of death is found in those with a non-Q wave AMI and the lowest in those with confirmed or possible myocardial ischaemia. Thus, patients with a Q wave AMI have a long term mortality risk intermediate between the two fractions defined as having unstable coronary artery disease. However, adjusting these results for age and history of cardiovascular disease eliminated the observed diVerence in mortality between non-Q wave and Q wave AMI. Furthermore, an imbalance in drug regimens might have aVected the outcome. (Heart 2001;86:391-396)

Unstable Angina and Non-ST Elevation Acute Coronary Syndrome Epidemiology and Current Management in Japan (Japan Multicenter Investigation for Cardiovascular Disease-D (JMIC-D) Committee)

“…8 Of 2 investigations of patients admitted to the ICU or CCU, 1 showed that the number of AMI patients was more than twice that of UA patients, 9 and the other revealed that UA patients outnumbered AMI patients by a ratio of 1.5 to 1. 10 The ratio of UA vs AMI patients obtained in the present study, which involved inpatients only, might be different if those treated as outpatients had been included. Because the largest percentage of UA patients in the case report investigation had Braunwald class III disease, those with Braunwald class I or II disease may have been treated on an outpatient basis.…”

Long-Term Mortality of Patients Undergoing Cardiac Catheterization for ST-Elevation and Non-ST-Elevation Myocardial Infarction

“…2 The contemporary definition of MI, introduced in 1999 3 and revised in 2007 4 , focused on circulating biomarkers, predominantly troponin, that detect myocardial necrosis with high sensitivity. However, most of the prior studies that investigated long-term outcomes on the basis of MI classification focused on non-Q-wave MI versus Q-wave MI comparisons, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] whereas fewer contemporary studies have used the newer troponin-based MI definition and classification system (STEMI versus NSTEMI). [21][22][23][24] …”

Cost Effectiveness of Fondaparinux in Non-ST-Elevation Acute Coronary Syndrome

“…The study is based on a previously reported decision tree, [20] validated in several external cohorts [8,15,[37][38][39][40] and tailored to the purpose and available data. The model compares two alternative strategies in patients experiencing a first episode of NSTE-ACS pretreated with aspirin, clopidogrel and a glycoprotein IIb/IIIa antagonist and undergoing early coronary catheterization.…”