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Improved long-term prognosis for patients with unstable coronary syndromes 1988-1995
P Abrahamsson1, A Rosengren, M Dellborg
1Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Insights
A more aggressive approach to acute coronary syndromes significantly reduced long-term mortality between 1988 and 1995. This trend was observed across various patient demographics and conditions, indicating improved outcomes for unstable angina and myocardial infarction patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- The management of acute coronary syndromes has evolved towards more aggressive treatment strategies over the past decade.
- Assessing the long-term impact of these evolving approaches on patient outcomes is crucial for clinical practice.
Purpose of the Study:
- To investigate the long-term survival rates of patients diagnosed with acute coronary syndromes.
- To analyze the relationship between the period of admission and patient outcomes since 1988.
Main Methods:
- A cohort of 3918 patients with unstable angina or non-Q wave myocardial infarction admitted between 1988 and 1997 was studied.
- Standardized diagnostic criteria were applied for both conditions.
- Long-term vital status and cause of death were obtained from the national mortality register.
Main Results:
- Two-year mortality declined from 30% in 1988 to 19% in 1995, showing a consistent annual decrease.
- This mortality reduction was consistent across diverse patient subgroups, including those with comorbidities or receiving specific treatments.
- Ten-year cumulative survival rates were 53% for unstable angina and 36% for non-Q wave myocardial infarction.
Conclusions:
- The adoption of a more aggressive management strategy for acute coronary syndromes has led to a significant decrease in long-term mortality.
- These findings underscore the effectiveness of contemporary treatment paradigms in improving survival for patients with acute coronary syndromes.
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 Ostra 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 0.7 microkat x l(-1), serial creatine kinase above 3.3 microkat x l(-1) or serial creatine kinaseMB subunit mass concentration above 15 microg x 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.
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