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Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006-2016.
Heart. 2020 02; 106(3):221-227.H

Abstract

OBJECTIVES

Recent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.

METHODS

All ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.

RESULTS

Over the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.

CONCLUSIONS

We observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

Authors+Show Affiliations

Department of Cardiology, Middlemore Hospital, Auckland, New Zealand tom.wang@middlemore.co.nz.Section of Epidemiology and Biostatics, School of Population Health University of Auckland, Auckland, New Zealand.National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.Section of Epidemiology and Biostatics, School of Population Health University of Auckland, Auckland, New Zealand.Department of Cardiology, Middlemore Hospital, Auckland, New Zealand. Section of Epidemiology and Biostatics, School of Population Health University of Auckland, Auckland, New Zealand.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31672778

Citation

Wang, Tom Kai Ming, et al. "Nationwide Trends in Acute Coronary Syndrome By Subtype in New Zealand 2006-2016." Heart (British Cardiac Society), vol. 106, no. 3, 2020, pp. 221-227.
Wang TKM, Grey C, Jiang Y, et al. Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006-2016. Heart. 2020;106(3):221-227.
Wang, T. K. M., Grey, C., Jiang, Y., Jackson, R. T., & Kerr, A. J. (2020). Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006-2016. Heart (British Cardiac Society), 106(3), 221-227. https://doi.org/10.1136/heartjnl-2019-315655
Wang TKM, et al. Nationwide Trends in Acute Coronary Syndrome By Subtype in New Zealand 2006-2016. Heart. 2020;106(3):221-227. PubMed PMID: 31672778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006-2016. AU - Wang,Tom Kai Ming, AU - Grey,Corina, AU - Jiang,Yannan, AU - Jackson,Rodney T, AU - Kerr,Andrew J, Y1 - 2019/10/31/ PY - 2019/07/11/received PY - 2019/10/02/revised PY - 2019/10/14/accepted PY - 2019/11/2/pubmed PY - 2020/7/7/medline PY - 2019/11/2/entrez KW - acute coronary syndromes KW - coronary artery disease KW - epidemiology SP - 221 EP - 227 JF - Heart (British Cardiac Society) JO - Heart VL - 106 IS - 3 N2 - OBJECTIVES: Recent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand. METHODS: All ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex. RESULTS: Over the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA. CONCLUSIONS: We observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/31672778/Nationwide_trends_in_acute_coronary_syndrome_by_subtype_in_New_Zealand_2006_2016_ L2 - https://heart.bmj.com/lookup/pmidlookup?view=long&amp;pmid=31672778 DB - PRIME DP - Unbound Medicine ER -