Skip Navigation

European Heart Journal 2000 21(7):533-539; doi:10.1053/euhj.1999.1940
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Abrahamsson, P
Right arrow Articles by Dellborg, M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Abrahamsson, P
Right arrow Articles by Dellborg, M
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Improved long-term prognosis for patients with unstable coronary syndromes 1988–1995

P Abrahamssonf1, A Rosengren and M Dellborg

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.

References

  1. Fuster V, Steele PM, Cheesbro JH. Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. J Am Coll Cardiol. 1985;:5–84B
  2. Depre C, Wijns W, Robert AM, Renkin JP, Havaux X. Pathology of unstable plaque: correlation with the clinical severity of acute coronary syndromes. J Am Coll Cardiol. 1997;30:694–702[Abstract]
  3. Theroux P, Fuster V. Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction. Circulation. 1998;97:1195–1206[Free Full Text]
  4. Gazes PC, Mobley EM Jr., Faris HM Jr., Duncan RC, Humphries GB. Preinfarctional (unstable) angina—a prospective study—ten year follow-up. Prognostic significance of electrocardiographic changes. Circulation. 1973;48:331–337[Abstract/Free Full Text]
  5. Mulcahy R, Al Awadhi AH, de Buitleor M, Tobin G, Johnson H, Contoy R. Natural history and prognosis of unstable angina. Am Heart J. 1985;109:753–758[CrossRef][Web of Science][Medline]
  6. Wilcox I, Freedman SB, Allman KC. Prognostic significance of a predischarge exercise test in risk stratification after unstable angina pectoris. J Am Coll Cardiol. 1991;18:677–683[Abstract]
  7. van Domburg RT, van Miltenburg van Zijl AJ, Veerhoek RJ, Simoons ML. Unstable angina: good long-term outcome after a complicated early course. J Am Coll Cardiol. 1998;31:1534–1539[Abstract/Free Full Text]
  8. Lancet. 1996;347:561–568[CrossRef][Web of Science][Medline]
  9. Cohen M, Demers C, Gurfinkel EP. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med. 1997;337:447–452[Abstract/Free Full Text]
  10. Theroux P, Waters D, Lam J, Juneau M, McCans J. Reactivation of unstable angina after the discontinuation of heparin. N Engl J Med. 1992;327:141–145[Abstract]
  11. Klein W, Buchwald A, Hillis SE. Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC). Circulation. 1997;96:61–68[Abstract/Free Full Text]
  12. Yusuf S, Flather M, Pogue J. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation. Lancet. 1998;352:507–514[CrossRef][Web of Science][Medline]
  13. Boden WE, O'Rourke RA, Crawford MH. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med. 1998;338:1785–1792[Abstract/Free Full Text]
  14. Halon DA, Flugelman MY, Merdler A, Rennert H, Shahla J, Lewis BS. Long-term (10-year) outcome in patients with unstable angina pectoris treated by coronary balloon angioplasty. J Am Coll Cardiol. 1998;32:1603–1609[Abstract/Free Full Text]
  15. Circulation. 1994;89:1545–1556[Abstract/Free Full Text]
  16. Luchi RJ, Scott SM, Deupree RH. Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1987;316:977–984[Abstract]
  17. Lancet. 1999;354:708–715[CrossRef][Web of Science][Medline]
  18. Hochman JS, McCabe CH, Stone PH. Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB. TIMI Investigators. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1997;30:141–148[Abstract]
  19. Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988;223:405–418[Web of Science][Medline]
  20. Johannesson M, Jonsson B, Kjekshus J, Olsson AG, Pedersen TR, Wedel H. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. Scandinavian Simvastatin Survival Study Group. N Engl J Med. 1997;336:332–336[Abstract/Free Full Text]
  21. Sacks FM, Pfeffer MA, Moye LA. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001–1009[Abstract/Free Full Text]
  22. N Engl J Med. 1998;339:1349–1357[Abstract/Free Full Text]
  23. Rubins HB, Robins SJ, Iwane MK. Rationale and design of the Department of Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (HIT) for secondary prevention of coronary artery disease in men with low high-density lipoprotein cholesterol and desirable low-density lipoprotein cholesterol. Am J Cardiol. 1993;71:45–52[CrossRef][Web of Science][Medline]
  24. Theroux P, Ouimet H, McCans J. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319:1105–1111[Abstract]
  25. Lancet. 1990;336:827–830[CrossRef][Web of Science][Medline]
  26. Lewis HD Jr., Davis JW, Archibald DG. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1983;309:396–403[Abstract]
  27. Cairns JA, Gent M, Singer J. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985;313:1369–1375[Abstract]
  28. Wilhelmsen L. ESC Population Studies Lecture 1996. Cardiovascular monitoring of a city over 30 years. Eur Heart J. 1997;18:1220–1230[Abstract/Free Full Text]
  29. Abrahamsson P, Dellborg M, Rosengren A, Wilhelmsen L. Improved long term prognosis after myocardial infarction 1984–1991. Eur Heart J. 1998;19:1512–1517[Abstract/Free Full Text]
  30. Dellborg M, Andersen K. Key factors in the identification of the high-risk patient with unstable coronary artery disease: clinical findings, resting 12-lead electrocardiogram, and continuous electrocardiographic monitoring. Am J Cardiol. 1997;80:35e–39e
  31. Patel DJ, Knight CJ, Holdright DR. Long-term prognosis in unstable angina. The importance of early risk stratification using continuous ST segment monitoring. Eur Heart J. 1998;19:240–249[Abstract/Free Full Text]
  32. Andersen K, Eriksson P, Dellborg M. Ischaemia detected by continuous on-line vectorcardiographic monitoring predicts unfavourable outcome in patients admitted with probable unstable coronary disease. Coron Artery Dis. 1996;7:753–760[Web of Science][Medline]
  33. Andersen K, Eriksson P, Dellborg M. Non-invasive risk stratification within 48 hours of hospital admission in patients with unstable coronary disease. Eur Heart J. 1997;18:780–788[Abstract/Free Full Text]
  34. Holmvang L, Luscher MS, Clemmensen P, Thygesen K, Grande P. Very early risk stratification using combined ECG and biochemical assessment in patients with unstable coronary artery disease (A thrombin inhibition in myocardial ischemia [TRIM] substudy). The TRIM Study Group. Circulation. 1998;98:2004–2009[Abstract/Free Full Text]
  35. Newby LK, Christenson RH, Ohman EM. Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. The GUSTO-IIa Investigators. Circulation. 1998;98:1853–1859[Abstract/Free Full Text]
  36. Antman EM, Sacks DB, Rifai N, McCabe CH, Cannon CP, Braunwald E. Time to positivity of a rapid bedside assay for cardiac-specific troponin T predicts prognosis in acute coronary syndromes: a Thrombolysis in Myocardial Infarction (TIMI) 11A substudy. J Am Coll Cardiol. 1998;31:326–330[Abstract/Free Full Text]
  37. Lindahl B, Venge P, Wallentin L. Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease. The FRISC study group. Circulation. 1996;93:1651–1657[Abstract/Free Full Text]
  38. Lindahl B, Venge P, Wallentin L. Troponin T identifies patients with unstable coronary disease who benefit from long term antithrombotic protection. J Am Coll Cardiol. 1997;29:43–48[Abstract]
  39. Lindahl B, Andren B, Ohlsson J, Venge P, Wallentin L. Noninvasive risk stratification in unstable coronary artery disease: exercise test and biochemical markers. FRISC Study Group. Am J Cardiol. 1997;80:40e–44e
  40. Ohman EM, Armstrong PW, Christenson RH. Cardiac troponin T levels for risk stratification in acute myocardial ischaemia. N Eng J Med. 1996;335:1333–1341[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Int J EpidemiolHome page
E. Huovinen, T. Harkanen, T. Martelin, S. Koskinen, and A. Aromaa
Predicting coronary heart disease mortality--assessing uncertainties in population forecasts and death probabilities by using Bayesian inference
Int. J. Epidemiol., October 1, 2006; 35(5): 1246 - 1252.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A.-M. Svensson, D. K. McGuire, P. Abrahamsson, and M. Dellborg
Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events
Eur. Heart J., July 1, 2005; 26(13): 1255 - 1261.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. Kim, C. L. Emerman, R. K. Cydulka, B. H. Rowe, S. Clark, and C. A. Camargo
Prospective Multicenter Study of Relapse Following Emergency Department Treatment of COPD Exacerbation
Chest, February 1, 2004; 125(2): 473 - 481.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. N. Sabbah
The cardiac support device and the Myosplint: treating heart failure by targeting left ventricular size and shape
Ann. Thorac. Surg., June 1, 2003; 75(90060): S13 - 19.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J Herlitz, B W Karlson, M Sjolin, and J Lindqvist
Ten year mortality in subsets of patients with an acute coronary syndrome
Heart, October 1, 2001; 86(4): 391 - 396.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Abrahamsson, P
Right arrow Articles by Dellborg, M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Abrahamsson, P
Right arrow Articles by Dellborg, M
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?