The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

Maria D'Souza; Laura Sarkisian; Lotte Saaby; Tina S Poulsen; Oke Gerke; Torben B Larsen; Axel Cp Diederichsen; Nikolaj Jangaard; Søren Z Diederichsen; Susanne Hosbond; Jens Hove; Kristian Thygesen; Hans Mickley

doi:10.1016/j.amjmed.2015.01.044

The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

Maria D'Souza, Laura Sarkisian, Lotte Saaby, Tina S Poulsen, Oke Gerke, Torben B Larsen, Axel Cp Diederichsen, Nikolaj Jangaard, Søren Z Diederichsen, Susanne Hosbond, Jens Hove, Kristian Thygesen, Hans Mickley

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Abstract

BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been prospectively studied in unselected hospital patients.

METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at one single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.

RESULTS: Of 3.762 consecutive patients 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67% and STEMI in 26%. NSTEMI patients were older, more frequently women and had more co-morbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI and 25% of STEMI patients. Age adjusted log-rank statistics revealed differences in mortality: NSTEMI vs. unstable angina pectoris (p=0.0091) and NSTEMI vs. STEMI (p=0.0045).

CONCLUSIONS: The application of the universal definition together with the employment of a contemporary troponin assay appears to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this NSTEMI patients have a sustained higher mortality than patients with STEMI.

Original language	English
Journal	American Journal of Medicine
Volume	128
Issue number	8
Pages (from-to)	852-860
Number of pages	9
ISSN	0002-9343
DOIs	https://doi.org/10.1016/j.amjmed.2015.01.044
Publication status	Published - 2015

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D'Souza, M., Sarkisian, L., Saaby, L., Poulsen, T. S., Gerke, O., Larsen, T. B., Diederichsen, A. C., Jangaard, N., Diederichsen, S. Z., Hosbond, S., Hove, J., Thygesen, K., & Mickley, H. (2015). The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. American Journal of Medicine, 128(8), 852-860. https://doi.org/10.1016/j.amjmed.2015.01.044

@article{7bc8c45107f34da2bc822ee8d086a822,

title = "The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays",

abstract = "BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been prospectively studied in unselected hospital patients.METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at one single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.RESULTS: Of 3.762 consecutive patients 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67% and STEMI in 26%. NSTEMI patients were older, more frequently women and had more co-morbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI and 25% of STEMI patients. Age adjusted log-rank statistics revealed differences in mortality: NSTEMI vs. unstable angina pectoris (p=0.0091) and NSTEMI vs. STEMI (p=0.0045).CONCLUSIONS: The application of the universal definition together with the employment of a contemporary troponin assay appears to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this NSTEMI patients have a sustained higher mortality than patients with STEMI.",

author = "Maria D'Souza and Laura Sarkisian and Lotte Saaby and Poulsen, {Tina S} and Oke Gerke and Larsen, {Torben B} and Diederichsen, {Axel Cp} and Nikolaj Jangaard and Diederichsen, {S{\o}ren Z} and Susanne Hosbond and Jens Hove and Kristian Thygesen and Hans Mickley",

year = "2015",

doi = "10.1016/j.amjmed.2015.01.044",

language = "English",

volume = "128",

pages = "852--860",

journal = "American Journal of Medicine",

issn = "0002-9343",

publisher = "Elsevier",

number = "8",

}

D'Souza, M, Sarkisian, L, Saaby, L, Poulsen, TS, Gerke, O, Larsen, TB, Diederichsen, AC, Jangaard, N, Diederichsen, SZ, Hosbond, S, Hove, J, Thygesen, K & Mickley, H 2015, 'The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays', American Journal of Medicine, vol. 128, no. 8, pp. 852-860. https://doi.org/10.1016/j.amjmed.2015.01.044

TY - JOUR

T1 - The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

AU - D'Souza, Maria

AU - Sarkisian, Laura

AU - Saaby, Lotte

AU - Poulsen, Tina S

AU - Gerke, Oke

AU - Larsen, Torben B

AU - Diederichsen, Axel Cp

AU - Jangaard, Nikolaj

AU - Diederichsen, Søren Z

AU - Hosbond, Susanne

AU - Hove, Jens

AU - Thygesen, Kristian

AU - Mickley, Hans

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been prospectively studied in unselected hospital patients.METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at one single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.RESULTS: Of 3.762 consecutive patients 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67% and STEMI in 26%. NSTEMI patients were older, more frequently women and had more co-morbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI and 25% of STEMI patients. Age adjusted log-rank statistics revealed differences in mortality: NSTEMI vs. unstable angina pectoris (p=0.0091) and NSTEMI vs. STEMI (p=0.0045).CONCLUSIONS: The application of the universal definition together with the employment of a contemporary troponin assay appears to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this NSTEMI patients have a sustained higher mortality than patients with STEMI.

AB - BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been prospectively studied in unselected hospital patients.METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at one single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.RESULTS: Of 3.762 consecutive patients 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67% and STEMI in 26%. NSTEMI patients were older, more frequently women and had more co-morbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI and 25% of STEMI patients. Age adjusted log-rank statistics revealed differences in mortality: NSTEMI vs. unstable angina pectoris (p=0.0091) and NSTEMI vs. STEMI (p=0.0045).CONCLUSIONS: The application of the universal definition together with the employment of a contemporary troponin assay appears to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this NSTEMI patients have a sustained higher mortality than patients with STEMI.

U2 - 10.1016/j.amjmed.2015.01.044

DO - 10.1016/j.amjmed.2015.01.044

M3 - Journal article

C2 - 25820165

SN - 0002-9343

VL - 128

SP - 852

EP - 860

JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 8

ER -

The diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

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