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

Heart ◽  
2019 ◽  
Vol 105 (18) ◽  
pp. 1423-1431 ◽  
Author(s):  
Christian Puelacher ◽  
Mathias Gugala ◽  
Philip D Adamson ◽  
Anoop Shah ◽  
Andrew R Chapman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Relative Incidence ◽  
Incidence And Mortality ◽  
All Cause Mortality ◽  
St Elevation

ObjectiveAssess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI).DesignTwo 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.Results8992 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).ConclusionsThe relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.

P1695Incidence and outcomes of unstable angina compared to non-ST elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Puelacher ◽  
M Gugala ◽  
P D Adamson ◽  
A S V Shah ◽  
A R Chapmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
St Elevation ◽  
Heart Foundation

Abstract 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]). 1-year survival free from future AMI 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. Acknowledgement/Funding Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, British Heart Foundation Project Grants, Butler S

Telephonic transmission of 12-lead electrocardiograms during acute myocardial infarction

2005 ◽  
Vol 11 (4) ◽  
pp. 185-190 ◽  
Author(s):  
K Mischke ◽  
M Zarse ◽  
M Perkuhn ◽  
C Knackstedt ◽  
K Markus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Call Centre ◽  
Coronary Syndrome ◽  
False Positive Diagnosis ◽  
St Segment ◽  
St Elevation

To test the feasibility of a small and simple system for telephonic transmission of 12-lead electrocardiograms (ECGs), 70 patients with acute coronary syndrome admitted to the cardiac care unit (CCU) were included in a feasibility study. The transmission system consisted of a belt with multiple electrodes, which was positioned around the chest. The ECG signal was sent to a call centre via a standard telephone line. In parallel, a standard 12-lead ECG was recorded on site. In a retrospective analysis, each lead of the transmitted ECG was compared with the on-site 12-lead ECG with regard to ST-segment changes and final diagnosis. In all 37 patients with acute ST-elevation myocardial infarction, the diagnosis was correctly established on the basis of telephone-transmitted ECGs. In 96% of limb and 88% of chest leads, ST elevations which were visible in standard ECGs were correctly displayed on telephonically transmitted ECGs. In the remaining 33 patients no false-positive diagnosis was made using transtelephonic ECG analysis. A control group of 31 patients without apparent heart disease showed high concordance between standard ECGs and telephonically transmitted ECGs. Telephonically transmitted 12-lead ECGs interpreted by a hospital-based internist/cardiologist might allow a rapid and accurate diagnosis of ST-elevation myocardial infarction and may increase diagnostic safety for the emergency staff during prehospital decision making and treatment of acute myocardial infarction.

scholarly journals Assessment of Thrombolysis in Myocardial Infarction Risk Score in Acute Coronary Syndrome among Saudi and non-Saudi Patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

2018 ◽  
Vol 8 (1) ◽  
pp. 25-32
Author(s):  
Wesam A. Alhejily ◽  
Raneem Ahmed Fallatah ◽  
Haneen Hussain Alabsi ◽  
Hadeel Sameer Ashi ◽  
Shahad Majed Alharbi
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Risk Score ◽  
St Elevation Myocardial Infarction ◽  
University Hospital ◽  
Coronary Syndrome ◽  
King Abdulaziz University ◽  
St Elevation ◽  
Saudi Patients

Background: One third of all deaths worldwide are attributed to acute coronary syndrome. The thrombolysis in Myocardial Infarction Risk Score is used to assess the risk of mortality and major adverse outcomes in this population. This study aimed to assess and compare the morbidity and mortality differences rate between Saudi and non-Saudi patients with acute coronary syndrome. Methods: This retrospective study was conducted at the coronary care unit of King Abdulaziz University Hospital. All acute coronary syndrome cases were enrolled and assessed using the thrombolysis in Myocardial Infarction Risk Score. Results: 242 cases were divided as 98 ST-elevation myocardial infarction cases and 144 unstable angina/non ST-elevation myocardial infarction. Among ST-elevation myocardial infarction patients 21 were Saudi patients and 77 were non-Saudi patients with the median thrombolysis in myocardial infarction risk score for Saudi was 5 and for non-Saudi 3.5 (P = 0.6). Unstable angina/non ST-elevation myocardial infarction cases had 47 Saudi patients and 94 non-Saudi patients with the median score was 4.2 for Saudis versus 4.5 for non-Saudis (P = 0.4). Conclusion: Overall thrombolysis in myocardial infarction were higher in Saudis with ST-elevation myocardial infarction than non-Saudis, and higher for non-Saudis with unstable angina/non ST-elevation myocardial infarction than Saudis. However, the difference was not significant (p = 0.6, p = 0.4). The 30 days and one-year mortality as well as major adverse cardiac events were similar between the two groups in ST-elevation myocardial infarction (P = 0.4 and 0.7) and unstable angina/non ST-elevation myocardial infarction population (P = 0.3 and 0.3).

scholarly journals A case report of a giant hiatal hernia mimicking an ST-elevation myocardial infarction

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Maria Rubini Gimenez ◽  
Leander Gonzalez Jurka ◽  
Michael J Zellweger ◽  
Philip Haaf
Keyword(s):  
Myocardial Infarction ◽  
Hiatal Hernia ◽  
Incidental Finding ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
St Elevation Myocardial Infarction ◽  
Exertional Dyspnoea ◽  
Coronary Syndrome ◽  
Giant Hiatal Hernia ◽  
St Elevation

Abstract Background Acute coronary syndrome (ACS) can be a life-threatening condition. However, identification of patients with ACS can be challenging, especially among women, and clinical presentation can often overlap with other medical entities. Case summary A 61-year-old woman with a history of stable bronchial asthma presented with worsening dyspnoea for spiroergometry. During bicycle exercise testing, she developed acute chest pain and her electrocardiogram showed significant ST-segment elevations. High-sensitivity cardiac troponin was elevated and a coronary angiography was performed showing normal coronary arteries. Cardiac magnetic resonance imaging showed no signs of myocardial infarction, myocarditis or Takotsubo cardiomyopathy but the incidental finding of a giant hiatal hernia impeding the filling of the left atrium. The giant hernia was surgically corrected, and the patient’s exertional dyspnoea fully relieved during follow-up. Discussion Hiatal hernia might compress cardiac structures, cause exertional dyspnoea and mimic ST-elevation myocardial infarction.

Acute coronary syndromes

2018 ◽  
Author(s):  
Cheerag Shirodaria ◽  
Sam Dawkins
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Myocardial Necrosis ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Depression ◽  
Wave Inversion ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Difference

The term ‘acute coronary syndrome’ includes unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). The difference between these three syndromes is as follows. In STEMI and NSTEMI, there is evidence of myocardial necrosis, as evidenced by raised cardiac enzymes, specifically, the very sensitive cardiac biomarker troponin. STEMI is diagnosed when the ECG shows persisting ST elevation in an appropriate territory consistent with STEMI whereas, in NSTEMI, there can be any or no ECG changes, or very transient, self-limiting ST elevation. In unstable angina, there is no myocardial necrosis, and troponins are normal. The ECG is as for NSTEMI and often shows no change, ST depression, or T-wave inversion. The prognoses in STEMI and NSTEMI are identical; unstable angina has a better prognosis than either STEMI or NSTEMI.

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