Outcomes in patients with acute and stable coronary syndromes; insights from the prospective NOBORI-2 study.

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Abstract

Contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease.

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Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE).

Philippe Gabriel Steg, Robert J Goldberg, Joel M Gore … (2002)

Acute coronary syndrome (ACS) represents a heterogenous spectrum of conditions. The Global Registry of Acute Coronary Events (GRACE) describes the epidemiology, management, and outcomes of patients with ACS. Data were collected from 11,543 patients enrolled in 14 countries. Of these patients, 30% had ST-segment elevation myocardial infarction (STEMI), 25% had non-ST-segment elevation myocardial infarction (NSTEMI), 38% had unstable angina pectoris, and 7% had other cardiac or noncardiac diagnoses. Over half of these patients (53%) were >/=65 years old. Reperfusion therapy was used in 62% of patients with STEMI. Percutaneous coronary intervention was performed in 40% of these subjects during the index admission. Intravenous glycoprotein IIb/IIIa blockers were used in 23%, 20%, and 7% of patients with STEMI, NSTEMI, and unstable angina, respectively (STEMI vs NSTEMI, p = 0.0018, and for either group vs unstable angina, p <0.001). Coronary artery bypass grafting was performed in 4%, 10%, and 5% of patients, respectively (p <0.0001). Hospital case fatality rates were markedly different among patients with STEMI, NSTEMI, and unstable angina (7%, 6%, and 3%, respectively; STEMI vs NSTEMI, p = 0.0459, and for either group vs unstable angina, p <0.001). Congestive heart failure complicated the hospital course in 18%, 18%, and 10% of the patients, respectively (p <0.0001), and recurrent angina with ST-segment changes occurred before discharge in 10%, 10%, and 9% of patients, respectively (p = 0.2644). GRACE provides a detailed and comprehensive global description of the spectrum of patients with ACS.

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STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry).

Gilles Montalescot, Jean Dallongeville, Eric Van Belle … (2007)

The ESC/ACC redefined myocardial infarction as any amount of necrosis caused by ischaemia. The aim of this study was to describe the management and outcomes using 'real-world' data taking the new definition of acute myocardial infarction into account. A total of 2,151 consecutive patients (76.0% men) with a myocardial infarction were enrolled at 56 centres in France. The median delay to presentation was shorter in patients with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI) (4 vs. 7 h, P < 0.0001). STEMI patients were more likely to receive fibrinolysis (28.9 vs. 0.7%, P < 0.0001) or undergo PCI (71.0 vs. 51.6%, P < 0.0001) but less likely to have bypass surgery (3.1 vs. 4.9%, P < 0.05). At discharge, patients with STEMI received more aggressive secondary prevention therapies than those with NSTEMI, which was not supported by differences in disease severity. A total of 1878 patients were followed-up for 1 year: 36.7% of STEMI and 41.5% of NSTEMI patients were rehospitalized (P = 0.05); 16% in both groups were revascularized. In-hospital mortality was similar (4.6 vs. 4.3%), and 1-year mortality was 9.0% in STEMI patients and 11.6% in NSTEMI patients (Log-Rank P = 0.09). Independent correlates of in-hospital mortality were untreated dyslipidaemia, advanced age, diabetes, and low blood pressure. The strongest predictors of 1-year mortality were heart failure and age. Similar predictors were found in STEMI and NSTEMI subgroups. Despite different management, patients with STEMI and NSTEMI have similar prognoses and independent correlates of outcome. These findings support the new definition of myocardial infarction.

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Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital.

V Virtanen, Jussi Mikkelsson, O Niemelä … (2006)

Based on randomized clinical trials, mortality of acute coronary syndrome (ACS) has been considered to be relatively low. The prognosis of clinical presentations of ACS in real-life patient cohorts has not been well documented. The aim of this study was to evaluate actual clinical outcome across the whole spectrum of ACS in a series of unselected prospectively collected consecutive patients from a defined geographical region, all admitted to one university hospital. A total of 1188 patients with ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI) or unstable angina pectoris (UA) were included. Results. In-hospital mortality was 9.6%, 13% and 2.6% (P<0.001) and mortality at a median follow-up of 10 months 19%, 27% and 12% (P<0.001), for the three ACS categories, respectively. In multivariate Cox regression analysis age, diabetes mellitus type 1, diuretic use at admission, creatinine level, lower systolic blood pressure, STEMI and NSTEMI ACS category were associated with higher mortality during follow-up. In an unselected patient cohort, short-term mortality of MI patients, especially those classified as NSTEMI, still was high despite increasing use of proven treatment modalities.

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Journal

Journal ID (iso-abbrev): PLoS ONE

Title: PloS one

Publisher: Public Library of Science (PLoS)

ISSN (Electronic): 1932-6203

ISSN (Print): 1932-6203

Publication date (Electronic): 2014

Volume: 9

Issue: 2

Affiliations

[1 ] Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.

[2 ] SBD Analytics, Hertstraat, Bekkevoort, Belgium.

[3 ] Division of Cardiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.

[4 ] Department of Cardiology, Rambam Medical Center, Haifa, Israel.

[5 ] European Medical and Clinical Division, Terumo Europe, Leuven, Belgium.

[6 ] Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom ; Cardiovascular Institute, University of Manchester, Manchester, United Kingdom.

Article

Publisher Item ID: PONE-D-13-32074

DOI: 10.1371/journal.pone.0088577

PMC ID: 3925145

PubMed ID: 24551120

SO-VID: 660a497b-1c0b-4907-87a9-ffd38c21c6df

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Outcomes in patients with acute and stable coronary syndromes; insights from the prospective NOBORI-2 study.

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Most cited references 3

Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE).

STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry).

Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital.

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