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Published on: January 28, 2020
[Mortality after acute coronary syndrome]
Kaes Al-Anee1, Ahmed Al-Ani, Magne Henriksen
1Sykehuset Østfold Moss, 1535 Moss.
Insights
This study on acute coronary syndrome found a 17.5% six-month mortality rate, which is higher than in clinical trials but similar to recent NSTEMI reports. Early PCI showed no deaths in STEMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Acute coronary syndrome (ACS) is a leading cause of hospitalization, necessitating effective interventions.
- Limited follow-up data exists for ACS patients in Norwegian local hospitals.
- This study addresses the need for local data on ACS outcomes.
Purpose of the Study:
- To evaluate the outcomes and mortality rates of patients with acute coronary syndrome in a local hospital setting.
- To provide follow-up data on ACS patients, stratified by STEMI, NSTEMI, and UAP.
- To compare local findings with existing national and international data.
Main Methods:
- Retrospective and prospective cohort study of 206 ACS patients from a local hospital.
- Classification of patients into ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UAP).
- Review of medical records, ECGs, and 6-month follow-up data for surviving patients.
Main Results:
- Overall 6-month mortality was 17.5% (STEMI: 14%, NSTEMI: 23%, UAP: 3%).
- Mean age at onset was 67 for STEMI and 76 for NSTEMI.
- No deaths were observed in STEMI patients receiving primary PCI within 12 hours of symptom onset.
Conclusions:
- Mortality in this ACS cohort exceeded rates reported in randomized trials.
- Observed mortality rates were comparable to recent reports for NSTEMI.
- Early primary PCI in STEMI patients appears to be associated with favorable outcomes.
Background:
Acute coronary syndrome is one of the most frequent indications for hospitalization. Acute intervention has been increasingly emphasized during the last decade. Norwegian local hospitals have few follow-up data for this condition.
Material And Methods:
A cohort from a local hospital with a catchment area of 100,000 inhabitants was studied retrospectively and followed-up prospectively. Journals and ECG results were reviewed for all patients who were admitted locally or referred to PCI with the diagnosis acute coronary syndrome. The patients were classified as having either myocardial infarction with ST-elevation (STEMI), myocardial infarction without ST-elevation (NSTEMI), or unstable angina pectoris (UAP). Surviving patients were contacted for 6-month follow-up data.
Results:
206 patients with acute coronary syndrome were included (37% women). There were 43 patients (22%) with STEMI, 127 (62%) with NSTEMI and 32 (17%) with UAP. The mean age for onset of myocardial infarction was 67 years in the STEMI group and 76 years in the NSTEMI group. Six months mortality rate for the entire group was 17.5%, and rates for the subgroups were STEMI (14%), NSTEMI (23%) and UAP (3%). There were no deaths in the 15 patients with STEMI who underwent primary PCI < 12 hours after onset.
Interpretation:
Mortality in acute coronary syndrome was higher in our study than for that reported in randomized trials, but comparable to recent reports on mortality in patients with NSTEMI.
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