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

Christian Puelacher; Mathias Gugala; Philip D Adamson; Anoop Shah; Andrew R Chapman; Atul Anand; Zaid Sabti; Jasper Boeddinghaus; Thomas Nestelberger; Raphael Twerenbold; Karin Wildi; Patrick Badertscher; Maria Rubini Gimenez; Samyut Shrestha; Lorraine Sazgary; Deborah Mueller; Lukas Schumacher; Nikola Kozhuharov; Dayana Flores; Jeanne du Fay de Lavallaz; Oscar Miro; Francisco Javier Martín-Sánchez; Beata Morawiec; Gregor Fahrni; Stefan Osswald; Tobias Reichlin; Nicholas L Mills; Christian Mueller

doi:10.1136/heartjnl-2018-314305

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

Christian Puelacher, Mathias Gugala, Philip D Adamson, Anoop Shah, Andrew R Chapman, Atul Anand, Zaid Sabti, Jasper Boeddinghaus, Thomas Nestelberger, Raphael Twerenbold, Karin Wildi, Patrick Badertscher, Maria Rubini Gimenez, Samyut Shrestha, Lorraine Sazgary, Deborah Mueller, Lukas Schumacher, Nikola Kozhuharov, Dayana Flores, Jeanne du Fay de LavallazOscar Miro, Francisco Javier Martín-Sánchez, Beata Morawiec, Gregor Fahrni, Stefan Osswald, Tobias Reichlin, Nicholas L Mills, Christian Mueller

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Journal	Heart
Early online date	24 Apr 2019
DOIs	https://doi.org/10.1136/heartjnl-2018-314305
Publication status	E-pub ahead of print - 24 Apr 2019

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10.1136/heartjnl-2018-314305

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Puelacher, C., Gugala, M., Adamson, P. D., Shah, A., Chapman, A. R., Anand, A., Sabti, Z., Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Wildi, K., Badertscher, P., Rubini Gimenez, M., Shrestha, S., Sazgary, L., Mueller, D., Schumacher, L., Kozhuharov, N., Flores, D., ... Mueller, C. (2019). Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart. Advance online publication. https://doi.org/10.1136/heartjnl-2018-314305

@article{6b241aa084254c7ca07e1b2cdf96815b,

title = "Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction",

abstract = "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.",

author = "Christian Puelacher and Mathias Gugala and Adamson, \{Philip D\} and Anoop Shah and Chapman, \{Andrew R\} and Atul Anand and Zaid Sabti and Jasper Boeddinghaus and Thomas Nestelberger and Raphael Twerenbold and Karin Wildi and Patrick Badertscher and \{Rubini Gimenez\}, Maria and Samyut Shrestha and Lorraine Sazgary and Deborah Mueller and Lukas Schumacher and Nikola Kozhuharov and Dayana Flores and \{du Fay de Lavallaz\}, Jeanne and Oscar Miro and Mart{\'i}n-S{\'a}nchez, \{Francisco Javier\} and Beata Morawiec and Gregor Fahrni and Stefan Osswald and Tobias Reichlin and Mills, \{Nicholas L\} and Christian Mueller",

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2019",

month = apr,

day = "24",

doi = "10.1136/heartjnl-2018-314305",

language = "English",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

}

Puelacher, C, Gugala, M, Adamson, PD, Shah, A, Chapman, AR, Anand, A, Sabti, Z, Boeddinghaus, J, Nestelberger, T, Twerenbold, R, Wildi, K, Badertscher, P, Rubini Gimenez, M, Shrestha, S, Sazgary, L, Mueller, D, Schumacher, L, Kozhuharov, N, Flores, D, du Fay de Lavallaz, J, Miro, O, Martín-Sánchez, FJ, Morawiec, B, Fahrni, G, Osswald, S, Reichlin, T, Mills, NL & Mueller, C 2019, 'Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction', Heart. https://doi.org/10.1136/heartjnl-2018-314305

TY - JOUR

T1 - Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction

AU - Puelacher, Christian

AU - Gugala, Mathias

AU - Adamson, Philip D

AU - Shah, Anoop

AU - Chapman, Andrew R

AU - Anand, Atul

AU - Sabti, Zaid

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Twerenbold, Raphael

AU - Wildi, Karin

AU - Badertscher, Patrick

AU - Rubini Gimenez, Maria

AU - Shrestha, Samyut

AU - Sazgary, Lorraine

AU - Mueller, Deborah

AU - Schumacher, Lukas

AU - Kozhuharov, Nikola

AU - Flores, Dayana

AU - du Fay de Lavallaz, Jeanne

AU - Miro, Oscar

AU - Martín-Sánchez, Francisco Javier

AU - Morawiec, Beata

AU - Fahrni, Gregor

AU - Osswald, Stefan

AU - Reichlin, Tobias

AU - Mills, Nicholas L

AU - Mueller, Christian

PY - 2019/4/24

Y1 - 2019/4/24

N2 - 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.

AB - 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.

U2 - 10.1136/heartjnl-2018-314305

DO - 10.1136/heartjnl-2018-314305

M3 - Article

C2 - 31018955

SN - 1355-6037

JO - Heart

JF - Heart

ER -

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

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