Copyright © 2000 by the European Society of Cardiology.
Improved long-term prognosis for patients with unstable coronary syndromes 1988–1995
Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
revised September 21, 1999; accepted September 28, 1999
Abstract
Aims A more aggressive approach to unstable coronary syndromes has developed over the last decade. We set out to examine the long-term outcome among patients with acute coronary syndromes with respect to period of admission since 1988.
Methods 3918 patients with unstable angina or a non-Q wave myocardial infarction who were admitted to the coronary care unit at Östra Hospital in the period 1988–1997 were included. Standardized criteria were used to define a non-Q wave myocardial infarction and included fulfilment of the following: (1) typical enzyme changes (serial serum aspartate aminotransferase above 0·7µkat.l–1, serial creatine kinase above 3·3µkat.l–1or serial creatine kinaseMBsubunit mass concentration above 15µg.l–1), and at least one of the following: (2) chest pain, shock, syncope or pulmonary oedema suggestive of a myocardial infarction, (3) development of electrocardiographic changes with serial ST-T changes without Q waves. The standardized criteria for unstable angina pectoris were fulfilment of at least one of the following: (1) a clear worsening of a previous stable pattern of angina pectoris, (2) chest pain at rest or minimal effort with transient ST-segment elevation or depression on electrocardiogram or elevation of cardiac enzymes not reaching the criteria for myocardial infarction. Information on vital status and cause of death after discharge was collected from the national cause-specific mortality register.
Results Two-year mortality decreased from 30% in 1988 to 19% in 1995 (relative risk per year 0·94 (0·90–0·97), 95% confidence interval). The improvement was consistent regardless of differences in age, prior myocardial infarction, diabetes mellitus, hypertension, development of non-Q wave myocardial infarction, treatment with heparin or thrombolytics or performance of acute coronary angiograms. The cumulative survival at 10 years was 53% in the unstable angina group and 36% in the non-Q wave myocardial infarction group (P<0·0001).
Conclusion Against a background of a more aggressive approach to acute coronary syndromes a decrease in long-term mortality is seen between 1988 and 1995.
Key Words: Unstable angina pectoris, acute myocardial infarction, prognosis
f1 Correspondence: P. Abrahamsson, Department of Medicine, Sahlgrenska Universitetssjukhuset/Östra, 416 86 Göteborg, Sweden.
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