title: Management and outcomes of acute coronary syndrome with minimal myocardial necrosis: analysis of a large prospective registry from a non-interventional centre.
abstract: The aim of this study was to assess the clinical risk of minimal myonecrosis below the cut-off for acute myocardial infarction (MI) in comparison with other grades of acute coronary syndrome (ACS). One-thousand four hundred and sixty seven consecutive patients with ACS admitted between May 2001 and April 2002 were studied in a non-interventional centre. Patients were divided into unstable angina (UA) (cTnT < 0.01 microg/l), non-ST elevation ACS with minimal myonecrosis (0.01 <or= cTnT < 0.1 microg/l), non-ST elevation MI (NSTEMI) (cTnT >or= 0.1 microg/L) and ST elevation myocardial infarction (STEMI). UA (n = 638) was associated with the fewest events at 6 months (2% cardiac death or MI). Patients with any myonecrosis (n = 829) had worse outcomes (6-month cardiac death or MI 18.3-23.3%). Compared with ACS patients with minimal myonecrosis, UA patients were at significantly lower risk (OR 0.21, 95% CI 0.12-0.45, p < 0.001), NSTEMI patients were at similar risk (OR 1.45, 95% CI 0.89-2.35, p = 0.13), and STEMI patients were at higher risk (OR 2.12 95% CI 1.26-3.85, p = 0.008) in adjusted analyses. Nearly 85% of cardiac deaths occurred within 6 months. The risk of adverse events was higher among patients managed by non-cardiologists (OR 1.66, 95% CI 1-2.75, p = 0.049). Patients with non-ST elevation ACS and minimal myonecrosis are a high-risk group more comparable with NSTEMI and clearly distinguishable from patients with UA.
authors.affiliation: Cardiology Department, Doncaster Royal Infirmary, Doncaster, UK. kkray@partners.org
authors.forename: K K
authors.initials: KK
authors.lastname: Ray
authors.forename: P J
authors.initials: PJ
authors.lastname: Sheridan
authors.forename: J
authors.initials: J
authors.lastname: Bolton
authors.forename: T C
authors.initials: TC
authors.lastname: Clayton
authors.forename: A
authors.initials: A
authors.lastname: Veitch
authors.forename: R
authors.initials: R
authors.lastname: Manivarmane
authors.forename: A
authors.initials: A
authors.lastname: Al Rifai
authors.forename: G
authors.initials: G
authors.lastname: Payne
authors.forename: W
authors.initials: W
authors.lastname: Baig
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy* / Q000473:pathology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors