High mortality rates in conservatively managed patients with acute coronary syndrome

Figures & data

Figure 1.  Flow-chart demonstrating number of patients and mortality in the different diagnostic categories.

Table I.  Baseline characteristics, according to different categories of patients presenting with chest pain

	STEMI^a (n = 126)	NSTEMI^b (n = 185)	UAP^c (n = 55)	CHD without ACS (n = 164)	Non-coronary chest pain (n = 225)	p-value
Age (years)	69 (55 – 80)	76 (64 – 84)	69 (60 – 77)	70 (59 – 81)	60 (48 – 75)	< 0.001
Male sex	81 (64%)	115 (62%)	30 (55%)	108 (66%)	114 (51%)	0.015
Medical history
Diabetes	12 (10%)	27 (15%)	8 (15%)	21 (13%)	21 (9%)	0.421
Prior AMI^e	14 (11%)	57 (31%)	19 (35%)	118 (72%)	0 (0%)	< 0.001
Stroke	4 (3%)	12 (7%)	5 (9%)	2 (1%)	4 (2%)	0.007
CABG^f	5 (4%)	17 (9%)	9 (16%)	56 (34%)	1 (0%)	< 0.001
PCI^g	4 (3%)	9 (5%)	4 (7%)	35 (21%)	0 (0%)	< 0.001

Categorical data are presented as n (%) and continuous data as median (inter-quartile range).

^aST-elevation myocardial infarction. ^bNon-ST-elevation myocardial infarction. CAD: coronary artery disease. ^cUnstable angina pectoris. ^dCoronary heart disease. ^eAcute myocardial infarction. ^fCoronary artery bypass grafting. ^gPercutaneous coronary intervention.

Statistics: Kruskal-Wallis or χ² tests as appropriate.

Figure 2.  Cumulative incidence of revascularisation during follow-up.

Table II.  Medication during one-year follow-up according to different categories of acute coronary syndrome.

	STEMI^a n = 126	NSTEMI^b n = 185	UAP^c	P-value n = 55
Medication during index hospitalisation
Aspirin	116 (92%)	152 (82%)	47 (86%)	0.046
Warfarin	16 (13%)	23 (12%)	8 (15%)	0.917
Clopidogrel	37 (29%)	138 (75%)	34 (62%)	< 0.001
CCB^d	7 (6%)	40 (22%)	16 (29%)	< 0.001
Beta-blocker	117 (93%)	159 (86%)	45 (82%)	0.067
Statin	106 (84%)	118 (64%)	32 (58%)	< 0.001
ACE-I^e	55 (44%)	63 (34%)	14 (26%)	0.046
ARB^f	7 (6%)	15 (8%)	7 (13%)	0.256
Medication at discharge	n = 116	n = 160	n = 55
Aspirin	100 (86%)	122 (76%)	41 (75%)	0.080
Warfarin	14 (12%)	22 (14%)	7 (13%)	0.918
Clopidogrel	20 (17%)	90 (56%)	19 (35%)	< 0.001
CCB^d	4 (3%)	29 (18%)	12 (22%)	< 0.001
Beta-blocker	107 (92%)	138 (86%)	45 (82%)	0.119
Statin	97 (84%)	106 (66%)	34 (62%)	0.001
ACE-I^e	52 (45%)	56 (35%)	14 (26%)	0.039
ARB^f	4 (3%)	11 (7%)	5 (9%)	0.271
Medication at 6 months	n = 78	n = 86	n = 38
Aspirin	68 (87%)	64 (74%)	24 (63%)	0.011
Warfarin	8 (10%)	14 (16%)	10 (26%)	0.084
Clopidogrel	40 (51%)	46 (54%)	11 (29%)	0.032
CCB^d	7 (9%)	18 (21%)	14 (37%)	0.002
Beta-blocker	74 (95%)	74 (86%)	28 (74%)	0.006
Statin	70 (90%)	69 (80%)	27 (71%)	0.039
ACE-I^e	34 (44%)	30 (35%)	12 (32%)	0.343
ARB^f	6 (8%)	10 (12%)	8 (21%)	0.119
Medication at 12 months	n = 74	n = 79	n = 35
Aspirin	66 (89%)	54 (68%)	22 (63%)	0.002
Warfarin	7 (10%)	14 (18%)	9 (26%)	0.082
Clopidogrel	32 (43%)	33 (42%)	10 (29%)	0.311
CCB^d	4 (5%)	14 (18%)	15 (43%)	< 0.001
Beta-blocker	68 (92%)	66 (84%)	27 (77%)	0.096
Statin	67 (91%)	65 (82%)	25 (71%)	0.040
ACE-I^e	30 (41%)	34 (43%)	12 (34%)	0.709
ARB^f	8 (11%)	12 (15%)	8 (23%)	0.255

Data are presented as n (%).

^aST-elevation myocardial infarction. ^bNon-ST-elevation myocardial infarction. ^cUnstable angina pectoris. ^dCalcium channel blocker. ^eAngiotensin converting enzyme inhibitor. ^fAngiotensin receptor blocker.

Figure 3.  Kaplan-Meier estimates of patient survival for the five diagnostic categories. Day 0 is day of admission to the emergency room.

Table III.  Hazard ratios (HR) of death in the different categories of patients with chest pain during the one-year follow-up.

	Univariate Cox regression analysis			Multiple Cox regression analysis
	HR	95% CI	p-value	HR	95% CI	p-value
Non-coronary chest pain	1.00			1.00
CHD^a without ACS^b	3.77	1.48 – 9.64	0.006	1.49	0.55 – 4.07	0.438
Unstable angina pectoris	2.79	0.79 – 9.89	0.112	1.54	0.43 – 5.58	0.508
ST-elevation MI	8.36	3.43 – 20.38	< 0.001	5.70	2.32 – 13.98	< 0.001
Non-ST-elevation MI	14.77	6.38 – 34.20	< 0.001	5.75	2.40 – 13.79	< 0.001
Age	1.08	1.06 – 1.10	< 0.001	1.08	1.06 – 1.10	< 0.001
Male sex	1.41	0.95 – 2.09	0.089	1.99	1.30 – 3.03	0.002
Diabetes mellitus	1.46	0.88 – 2.42	0.140	0.81	0.48 – 1.37	0.437
Prior AMI	2.39	1.64 – 3.47	< 0.001	1.76	1.14 – 2.71	0.011
Stroke	1.50	0.66 – 3.42	0.334	NA^c	NA^c	NA^c

^aCoronary heart disease. ^bAcute coronary syndrome. ^cNot addressed. The results of univariate and multiple proportional hazards regression analyses are shown. Variables associated with death in the univariate analyses (p < 0.20) were included in the multiple regression model.