PT  - JOURNAL ARTICLE
AU  - Christian Puelacher
AU  - Mathias Gugala
AU  - Philip D Adamson
AU  - Anoop Shah
AU  - Andrew R Chapman
AU  - Atul Anand
AU  - Zaid Sabti
AU  - Jasper Boeddinghaus
AU  - Thomas Nestelberger
AU  - Raphael Twerenbold
AU  - Karin Wildi
AU  - Patrick Badertscher
AU  - Maria Rubini Gimenez
AU  - Samyut Shrestha
AU  - Lorraine Sazgary
AU  - Deborah Mueller
AU  - Lukas Schumacher
AU  - Nikola Kozhuharov
AU  - Dayana Flores
AU  - Jeanne du Fay de Lavallaz
AU  - Oscar Miro
AU  - Francisco Javier Martín-Sánchez
AU  - Beata Morawiec
AU  - Gregor Fahrni
AU  - Stefan Osswald
AU  - Tobias Reichlin
AU  - Nicholas L Mills
AU  - Christian Mueller
TI  - Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction
AID  - 10.1136/heartjnl-2018-314305
DP  - 2019 Sep 01
TA  - Heart
PG  - 1423--1431
VI  - 105
IP  - 18
4099  - http://heart.bmj.com/content/105/18/1423.short
4100  - http://heart.bmj.com/content/105/18/1423.full
SO  - Heart2019 Sep 01; 105
AB  - Objective Assess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI).Design Two independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year.Results 8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0).Conclusions The relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.