Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

TY - JOUR

T1 - Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

AU - D'Souza, Maria

AU - Sarkisian, Laura

AU - Saaby, Lotte

AU - Poulsen, Tina S

AU - Gerke, Oke

AU - Larsen, Torben B.

AU - Diederichsen, Axel C P

AU - Jangaard, Nikolaj

AU - Diederichsen, Søren Z

AU - Hosbond, Susanne

AU - Hove, Jens

AU - Thygesen, Kristian

AU - Mickley, Hans

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients.METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.RESULTS: Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045).CONCLUSIONS: The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI.

AB - BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients.METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.RESULTS: Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045).CONCLUSIONS: The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI.

KW - Aged

KW - Angina, Unstable

KW - Biomarkers

KW - Denmark

KW - Diagnosis, Differential

KW - Electrocardiography

KW - Female

KW - Humans

KW - Immunoassay

KW - Male

KW - Myocardial Infarction

KW - Prospective Studies

KW - Survival Rate

KW - Troponin I

U2 - 10.1016/j.amjmed.2015.01.044

DO - 10.1016/j.amjmed.2015.01.044

M3 - Journal article

C2 - 25820165

SN - 0002-9343

VL - 128

SP - 852

EP - 860

JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 8

ER -