One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry)


      The objective of this study was to determine the management and outcome of fewer selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge. The Canadian Acute Coronary Syndromes Registry was a prospective observational study of patients admitted with suspected acute coronary syndromes. Data on demographic and clinical characteristics, in-hospital treatment, and outcomes were recorded. At 1 year, vital status, medication use, recurrent cardiac events, and procedures were determined by telephone contact. Of the 5,312 patients enrolled, 4,627 had a final diagnosis of acute coronary syndrome, with Q-wave myocardial infarction in 27.7%, non–Q-wave myocardial infarction in 33.2%, and unstable angina pectoris in 39.1%. During hospitalization, coronary angiography and revascularization were performed in 39.6% and 20.3% of patients, respectively. The in-hospital mortality rate was 2.4% overall. At discharge, 87.8%, 76.4%, 56.0%, and 54.8% of patients were prescribed aspirin, β blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents, respectively. Unadjusted 1-year mortality rates for hospital survivors were 6.5%, 10%, and 5.4% for those with Q-wave myocardial infarction, non–Q-wave myocardial infarction, and unstable angina pectoris groups, respectively (p <0.0001). This difference in mortality rate remained significant after adjusting for other prognosticators, whereas the use of coronary angiography and revascularization after discharge was similar across patients. At 1 year, fewer patients were maintained on aspirin and β blockers, whereas the use of lipid-lowering therapy increased (all p <0.0001). Despite similar rates of coronary angiography and revascularization after discharge, patients with non–Q-wave myocardial infarction had worse outcomes at 1 year. Moreover, there was a significant opportunity to enhance the discharge and long-term use of evidence-based secondary prevention therapies.
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        • Sackett D.L
        A primer on the precision and accuracy of the clinical examination.
        JAMA. 1992; 267: 2638-2644
        • Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II) Investigators
        Invasive compared with non-invasive treatment in unstable coronary-artery disease.
        Lancet. 1999; 354: 708-715
        • Hasdai D
        • Behar S
        • Wallentin L
        • Danchin N
        • Gitt A.K
        • Boersma E
        • Fioretti P.M
        • Simoons M.L
        • Battler A
        A prospective survey of the chartacteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin. The Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS).
        Eur Heart J. 2002; 23: 1190-1201
        • Steg P.G
        • Goldberg R.J
        • Gore J.M
        • Fox K.A.A
        • Eagle K.A
        • Flather M.D
        • Sadiq I
        • Kasper R
        • Rushton-Mellor S.K
        • Anderson F.A
        Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE).
        Am J Cardiol. 2002; 90: 358-363
        • Fox K.A.A
        • Goodman S.G
        • Klein W
        • Brieger D
        • Steg P.G
        • Avezum D.O
        • GRACE Investigators
        Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE).
        Eur Heart J. 2002; 23: 1177-1189
        • Braunwald E
        • Antman E.M
        • Beasley J.W
        • Califf R.M
        • Cheitlin M.D
        • Hochman J.S
        • Jones R.H
        • Kereiakes D
        • Kupersmith J
        • Levin T.N
        • et al.
        ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction.
        Circulation. 2002; 106: 1893-1900
        • Phibbs B
        • Marcus F
        • Marriott H.J.C
        • Moss A
        • Spodick D.H
        Q-wave versus non-Q wave myocardial infarction.
        J Am Coll Cardiol. 1999; 33: 576-582
        • Goodman S.G
        • Langer A.L
        • Ross A.M
        • Wildermann N.M
        • Barbagelata A
        • Sgarbossa E.B
        • Wagner G.S
        • Granger C.B
        • Califf R.M
        • Topol E.J
        • et al.
        Non–Q-wave versus Q-wave myocardial infarction after thrombolytic therapy. Angiographic and prognostic insights from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries-I Angiographic Substudy.
        Circulation. 1998; 97: 444-450
        • Goodman S.G
        • Barr A
        • Langer A.L
        • Wagner G.S
        • Fitchett D
        • Armstrong P.W
        • Naylor C.D
        Development and prognosis of non–Q-wave myocardial infarction in the thrombolytic era.
        Am Heart J. 2002; 144: 243-250
        • Furman M.I
        • Dauerman H.L
        • Goldberg R.J
        • Yarzbeski J
        • Lessard D
        • Gore J.M
        Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non–Q-wave myocardial infarction.
        J Am Coll Cardiol. 2001; 37: 1571-1580
        • Schwartz G.G
        • Olsson A.G
        • Ezekowitz M.D
        • Ganz P
        • Oliver M.F
        • Waters D
        • Zeiher A
        • Chaitman B.R
        • Leslie S
        • Stern T
        • Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering Study Investigators
        Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes. The MIRACL study.
        JAMA. 2001; 285: 1711-1718
        • Stenestrand U
        • Wallentin L
        • Swedish Register of Cardiac Intensive Care (RIKS-HIA)
        Early statin treatment following acute myocardial infarction and 1-year survival.
        JAMA. 2001; 285: 430-436
        • Aronow H.D
        • Topol E.J
        • Roe M.T
        • Houghtaling P.L
        • Wolski K.E
        • Lincoff A.M
        • Harrington R.A
        • Califf R.M
        • Ohman E.M
        • Kleiman N.S
        • et al.
        Effect of lipid-lowering therapy on early mortality after acute coronary syndromes.
        Lancet. 2001; 357: 1063-1068
        • Collinson J
        • Flather M.D
        • Fox K.A.A
        • Findlay I
        • Rodrigues E
        • Dooley P
        • Ludman P
        • Adgey J
        • Bowker T.J
        • Mattu R
        Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation.
        Eur Heart J. 2000; 21: 1450-1457
        • Freemantle N
        • Cleland J
        • Young P
        • Mason J
        • Harrison J
        β blockade after myocardial infarction.
        BMJ. 1999; 318: 1730-1737
        • Barron H.V
        • Michaels A.D
        • Maynard C
        • Every N.R
        • National Registry of Myocardial Infarction
        Use of angiotensin-converting enzyme inhibitors at discharge in patients with acute myocardial infarction in the United States.
        J Am Coll Cardiol. 1998; 32: 360-367
        • Khalil M.E
        • Basher A.W
        • Brown E.J
        • Alhaddad I.A
        A remarkable medical story.
        J Am Coll Cardiol. 2001; 37: 1757-1764
        • Butler J
        • Arbogast P.G
        • BeLue R
        • Daugherty J
        • Jain M.K
        • Ray W.A
        • Griffin M.R
        Outpatient adherence to beta-blocker therapy after acute myocardial infarction.
        J Am Coll Cardiol. 2002; 40: 1589-1595
        • Muhlestein J.B
        • Horne B.D
        • Bair T.L
        • Li Q
        • Madsen T.E
        • Pearson R.R
        • Anderson J.L
        Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality.
        Am J Cardiol. 2001; 87: 257-261
        • Alpert J.S
        Are data from clinical registries of any value?.
        Eur Heart J. 2000; 21: 1399-1401

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      • Correction
        American Journal of CardiologyVol. 95Issue 3
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          In the article titled, “One-Year Outcome of Patients After Acute Coronary Syndromes (from the Canadian Acute coronary Syndromes Registry)” by Yan et al in the July 1, 2004, issue of the AJC, there is an error on page 25, in the Abstract section. The corrected sentence should read: “The objective of this study was to determine the management and outcome of less selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge.”
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