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One-year health status outcomes of unstable angina versus myocardial infarction: a prospective, observational cohort study of ACS survivors.
BMC Cardiovasc Disord. 2007 Sep 12; 7:28.BC

Abstract

BACKGROUND

Unstable angina (UA) patients have lower mortality and reinfarction risks than ST-elevation (STEMI) or non-ST elevation myocardial infarction (NSTEMI) patients and, accordingly, receive less aggressive treatment. Little is known, however, about the health status outcomes (angina, physical function, and quality of life) of UA versus MI patients among survivors of an ACS hospitalization.

METHODS

In a cohort of 1,192 consecutively enrolled ACS survivors from two Kansas City hospitals, we evaluated the associations between ACS presentation (UA, NSTEMI, and STEMI) and one-year health status (angina, physical functioning and quality of life), one-year cardiac rehospitalization rates, and two-year mortality outcomes, using multivariable regression modeling.

RESULTS

After multivariable adjustment for demographic, hospital, co-morbidity, baseline health status, and treatment characteristics, UA patients had a greater prevalence of angina at 1 year than STEMI patients (adjusted relative risk [RR] = 1.42; 95% CI [1.06, 1.90]) and similar rates as NSTEMI patients (adjusted RR = 1.1; 95% CI [0.85, 1.42]). In addition, UA patients fared no better than MI patients in Short Form-12 physical component scores (UA vs. STEMI score difference -0.05 points; 95% CI [-2.41, 2.3]; UA vs. NSTEMI score difference -1.91 points; 95% CI [-4.01, 0.18]) or Seattle Angina Questionnaire quality of life scores (UA vs. STEMI score difference -1.39 points; 95% CI [-5.63, 2.85]; UA vs. NSTEMI score difference -0.24 points 95% CI [-4.01, 3.54]). Finally, UA patients had similar rehospitalization rates as MI patients (UA vs. STEMI adjusted hazard ratio [HR] = 1.31; 95% CI [0.86, 1.99]; UA vs. NSTEMI adjusted HR = 1.03; 95% CI [0.73, 1.47]), despite better 2-year survival (UA vs. STEMI adjusted HR = 0.51; 95% confidence interval (CI) [0.28, 0.95]; UA vs. NSTEMI adjusted HR = 0.40; 95% CI [0.24, 0.65]).

CONCLUSION

Although UA patients have better survival rates, they have similar or worse one-year health status outcomes and cardiac rehospitalization rates as compared with MI patients. Clinicians should be aware of the adverse health status outcome risks for UA patients and consider close monitoring for the opportunity to improve their health status and minimize the need for subsequent rehospitalization.

Authors+Show Affiliations

Denver VAMC/University of Colorado Health Science Center, Denver, CO, USA. thomas.maddox@va.govNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17850662

Citation

Maddox, Thomas M., et al. "One-year Health Status Outcomes of Unstable Angina Versus Myocardial Infarction: a Prospective, Observational Cohort Study of ACS Survivors." BMC Cardiovascular Disorders, vol. 7, 2007, p. 28.
Maddox TM, Reid KJ, Rumsfeld JS, et al. One-year health status outcomes of unstable angina versus myocardial infarction: a prospective, observational cohort study of ACS survivors. BMC Cardiovasc Disord. 2007;7:28.
Maddox, T. M., Reid, K. J., Rumsfeld, J. S., & Spertus, J. A. (2007). One-year health status outcomes of unstable angina versus myocardial infarction: a prospective, observational cohort study of ACS survivors. BMC Cardiovascular Disorders, 7, 28.
Maddox TM, et al. One-year Health Status Outcomes of Unstable Angina Versus Myocardial Infarction: a Prospective, Observational Cohort Study of ACS Survivors. BMC Cardiovasc Disord. 2007 Sep 12;7:28. PubMed PMID: 17850662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-year health status outcomes of unstable angina versus myocardial infarction: a prospective, observational cohort study of ACS survivors. AU - Maddox,Thomas M, AU - Reid,Kimberly J, AU - Rumsfeld,John S, AU - Spertus,John A, Y1 - 2007/09/12/ PY - 2007/01/16/received PY - 2007/09/12/accepted PY - 2007/9/14/pubmed PY - 2007/11/2/medline PY - 2007/9/14/entrez SP - 28 EP - 28 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 7 N2 - BACKGROUND: Unstable angina (UA) patients have lower mortality and reinfarction risks than ST-elevation (STEMI) or non-ST elevation myocardial infarction (NSTEMI) patients and, accordingly, receive less aggressive treatment. Little is known, however, about the health status outcomes (angina, physical function, and quality of life) of UA versus MI patients among survivors of an ACS hospitalization. METHODS: In a cohort of 1,192 consecutively enrolled ACS survivors from two Kansas City hospitals, we evaluated the associations between ACS presentation (UA, NSTEMI, and STEMI) and one-year health status (angina, physical functioning and quality of life), one-year cardiac rehospitalization rates, and two-year mortality outcomes, using multivariable regression modeling. RESULTS: After multivariable adjustment for demographic, hospital, co-morbidity, baseline health status, and treatment characteristics, UA patients had a greater prevalence of angina at 1 year than STEMI patients (adjusted relative risk [RR] = 1.42; 95% CI [1.06, 1.90]) and similar rates as NSTEMI patients (adjusted RR = 1.1; 95% CI [0.85, 1.42]). In addition, UA patients fared no better than MI patients in Short Form-12 physical component scores (UA vs. STEMI score difference -0.05 points; 95% CI [-2.41, 2.3]; UA vs. NSTEMI score difference -1.91 points; 95% CI [-4.01, 0.18]) or Seattle Angina Questionnaire quality of life scores (UA vs. STEMI score difference -1.39 points; 95% CI [-5.63, 2.85]; UA vs. NSTEMI score difference -0.24 points 95% CI [-4.01, 3.54]). Finally, UA patients had similar rehospitalization rates as MI patients (UA vs. STEMI adjusted hazard ratio [HR] = 1.31; 95% CI [0.86, 1.99]; UA vs. NSTEMI adjusted HR = 1.03; 95% CI [0.73, 1.47]), despite better 2-year survival (UA vs. STEMI adjusted HR = 0.51; 95% confidence interval (CI) [0.28, 0.95]; UA vs. NSTEMI adjusted HR = 0.40; 95% CI [0.24, 0.65]). CONCLUSION: Although UA patients have better survival rates, they have similar or worse one-year health status outcomes and cardiac rehospitalization rates as compared with MI patients. Clinicians should be aware of the adverse health status outcome risks for UA patients and consider close monitoring for the opportunity to improve their health status and minimize the need for subsequent rehospitalization. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/17850662/One_year_health_status_outcomes_of_unstable_angina_versus_myocardial_infarction:_a_prospective_observational_cohort_study_of_ACS_survivors_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-7-28 DB - PRIME DP - Unbound Medicine ER -