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Incidence and outcomes of unstable angina compared to non-ST elevation myocardial infarction
Authors : C Puelacher (Basel,CH), M Gugala (Basel,CH), PD Adamson (Edinburgh,GB), ASV Shah (Edinburgh,GB), AR Chapmann (Edinburgh,GB), A Anand (Edinburgh,GB), J Boeddinghaus (Basel,CH), T Nestelberger (Basel,CH), R Twerenbold (Basel,CH), K Wildi (Basel,CH), M Rubini Gimenez (Basel,CH), S Osswald (Basel,CH), NL Mills (Edinburgh,GB), C Mueller (Basel,CH)
C Puelacher1
,
M Gugala1
,
PD Adamson2
,
ASV Shah2
,
AR Chapmann2
,
A Anand2
,
J Boeddinghaus1
,
T Nestelberger1
,
R Twerenbold1
,
K Wildi1
,
M Rubini Gimenez1
,
S Osswald1
,
NL Mills2
,
C Mueller1
,
1University Hospital Basel, Cardiology - Basel - Switzerland
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2University of Edinburgh, BHF Center for Cardiovascular Science - Edinburgh - United Kingdom of Great Britain & Northern Ireland
,
Citation:
Objective: Assess the incidence and compare characteristics and outcome of unstable angina (UA) and Non-ST-Elevation myocardial infarction (NSTEMI)
Design: Two independent prospective multicenter 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 366/4122 (8.9%) and 137/4870 (2.8%) patients in APACE and High-STEACS, respectively, and NSTEMI in 622 (15.1%) and 651 (13.4%). Coronary artery disease was pre-existing in 73% and 76% of patients with unstable angina. At 30-days, all-cause mortality in UA was substantially lower as compared to NSTEMI (0.5% versus 3.7%, p=0.002 in APACE, 0.7% versus 7.4%, p=0.004 in High-STEACS). Similarly, at 1-year in UA all-cause mortality was 3.3% [95%CI 1.2-5.3] vs 10.4% [7.9-12.9] in APACE, and 5.1% [0.7-9.5] vs 22.9% [19.3-26.4] 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%, [7.8-14.6] and 7.9%, [5.7-10.2]), and higher than in NCCP (0.6%, [0.2-1.0]).
Conclusions: The incidence and the mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
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