CARDIOVASCULAR MEDICINE

Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990–2000: population-based cohort study

S Capewell¹, N F Murphy², K MacIntyre³, S Frame⁴, S Stewart², J W T Chalmers⁴, J Boyd⁴, A Finlayson⁴, A Redpath⁴, J J V McMurray²

¹ Department of Public Health, University of Liverpool, Liverpool, UK
² Department of Cardiology, Glasgow Western Infirmary, Glasgow, UK
³ Department of Public Health, University of Glasgow, Glasgow, UK
⁴ Information & Statistics Division, Edinburgh, UK

Correspondence to:
Professor Simon Capewell
Department of Public Health, University of Liverpool, Liverpool L69 3GB, UK; capewell{at}liverpool.ac.uk

Objective: To analyse short- and long-term outcomes and prognostic factors in a large population-based cohort of unselected patients with a first emergency admission for suspected acute coronary syndrome between 1990 and 2000 in Scotland.

Methods: All first emergency admissions for acute myocardial infarction (AMI) and all first emergency admissions for angina (the proxy for unstable angina) between 1990 and 2000 in Scotland (population 5.1 million) were identified. Survival to five years was examined by Cox multivariate modelling to examine the independent prognostic effects of diagnosis, age, sex, year of admission, socioeconomic deprivation and co-morbidity.

Results: In Scotland between 1990 and 2000, 133 429 individual patients had a first emergency admission for suspected acute coronary syndrome: 96 026 with AMI and 37 403 with angina. After exclusion of deaths within 30 days, crude five-year case fatality was similarly poor for patients with angina and those with AMI (23.9% v 21.6% in men and 23.5% v 26.0% in women). The longer-term risk of a subsequent fatal or non-fatal event in the five years after first hospital admission was high: 54% in men after AMI (53% in women) and 56% after angina (49% in women). Event rates increased threefold with increasing age and 20–60% with different co-morbidities, but were 11–34% lower in women.

Conclusions: Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year. Furthermore, half the patients experienced a fatal or non-fatal event within five years. These data may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome.

Abbreviations: AMI, acute myocardial infarction; CABG, coronary artery bypass graft; ICD, International classification of diseases

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Capewell, S., Hayes, D. K., Ford, E. S., Critchley, J. A., Croft, J. B., Greenlund, K. J., Labarthe, D. R. (2009). Life-Years Gained Among US Adults From Modern Treatments and Changes in the Prevalence of 6 Coronary Heart Disease Risk Factors Between 1980 and 2000. Am J Epidemiol 170: 229-236 [Abstract] [Full Text]  
• Gibson, P H, Croal, B L, Cuthbertson, B H, Gibson, G, Jeffrey, R R, Buchan, K G, El-Shafei, H, Hillis, G S (2009). Socio-economic status and early outcome from coronary artery bypass grafting. Heart 95: 793-798 [Abstract] [Full Text]  
• Capewell, S, O'Flaherty, M (2008). Maximising secondary prevention therapies in patients with coronary heart disease. Heart 94: 8-9 [Full Text]  
• Hughes, G. (2007). Hygieia. J. Epidemiol. Community Health 61: 176-176 [Full Text]  
• Junghans, C., Timmis, A. D (2006). Risk assessment after acute coronary syndrome. BMJ 333: 1079-1080 [Full Text]