Elsevier

American Heart Journal

Volume 142, Issue 5, November 2001, Pages 768-774
American Heart Journal

Interventional Cardiology
Early coronary angiography improves long-term survival in unstable angina☆,☆☆

https://doi.org/10.1067/mhj.2001.119126Get rights and content

Abstract

Background The role of early coronary angiography in the evaluation of patients with unstable angina has been controversial. This study was designed to determine the effect of early coronary angiography on long-term survival in patients with unstable angina. Methods We reviewed the Olmsted County Acute Chest Pain Database, a population-based epidemiologic registry that includes all patients residing within Olmsted County who were seen for emergency department evaluation of acute chest pain from 1985 to 1992. Patients with symptoms consistent with myocardial ischemia qualifying as unstable angina were classified as undergoing early (≤7 days of index presentation) angiography or not. Results A total of 2264 patients with symptoms consistent with unstable angina were identified with a mean duration of follow-up of 6 years; 892 underwent early angiography. Early angiography patients were younger; less likely to have heart failure; more likely to be male, hypercholesterolemic, and smokers; had prior coronary revascularization; and had a myocardial infarction at the index presentation. After baseline differences were controlled, early angiography was associated with a reduction in all-cause long-term mortality (relative risk 0.63, 95% CI 0.53-0.74). Patients at intermediate or high risk for death or myocardial infarction at presentation were most likely to benefit from early angiography. Conclusion Early angiography in the evaluation of patients with unstable angina was associated with a reduction in all-cause mortality, particularly in intermediate- and high-risk patients, in this retrospective population-based study. (Am Heart J 2001;142:768-74.)

Section snippets

Patient population

We retrospectively identified all residents of Olmsted County, Minnesota, seen in one of the county's 3 emergency departments with acute chest pain from January 1, 1985, through December 31, 1992; only one of these hospitals had facilities to perform coronary angiography and revascularization. All medical records were reviewed by an experienced nurse abstracter who identified those patients who had symptoms consistent with an unstable coronary syndrome, as defined by the Diamond classification.

Results

There were 6801 residents of Olmsted County who were seen for emergency room evaluation of acute chest pain during the study period. Of these, 2282 (33.4%) met the Diamond classification criteria for unstable angina. Eighteen patients who died while in the emergency department or within 1 day of admission and who had not had an angiogram within that time were excluded. The remaining 2264 patients comprised the study population with a mean follow up of 6.0 years (range 0 to 13.5 years). Of

Discussion

In this population-based retrospective analysis of patients with the clinical diagnosis of unstable angina, the use of an early invasive strategy was associated with a reduction in long-term mortality, particularly in patients who are at intermediate or high risk for short-term adverse cardiac events on the basis of AHCPR classification. Our retrospective population-based study, with long-term follow-up, is in keeping with the findings of the prospective FRISC II trial, where mortality was

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    • Cited by (6)

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    Supported by the Mayo Foundation.

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    Reprint requests: Verghese Mathew, MD, Division of Cardiovascular Disease, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: [email protected]

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