Survival after an acute coronary syndrome: 18‐month outcomes from the Australian and New Zealand SNAPSHOT ACS study

Brieger, David; Chew, Derek P.; Redfern, Julie; Ellis, Chris; Briffa, Tom; Howell, Tegwen; Aliprandi-Costa, B.; Astley, Carolyn; Gamble, Greg; Carr, Bridie; Hammett, C.; Board, Neville; French, John K.

doi:10.5694/mja15.00504

Cited by 26 publications

(24 citation statements)

References 20 publications

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“…In NSW the 2012 ACS SNAPSHOT showed the median angiography rate was 72%, which is a higher angiography rate than we report. A likely contribution to this is the development of functional clinical networks over the last 4–6 years across the state that have facilitated inter‐hospital transfer for delivery of escalated care including coronary angiography.…”

Section: Discussioncontrasting

confidence: 66%

“…Such invasive management may have not been performed (inappropriately) with a higher proportion not undergoing coronary angiography with small rather than large troponin elevations. In a 2 week ‘SNAPSHOT’ of patients presenting to Australian and New Zealand hospitals with ACS, a median of 75% of patients with acute MI underwent coronary angiography during their index admission with large variations in practice across institutions …”

Section: Discussionmentioning

confidence: 99%

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Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia

French

Brieger

Juergens

et al. 2020

Internal Medicine Journal

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Background: Cardiac troponin assays are very widely requested tests, particularly in emergency departments. Thus, many seriously ill patients who may not have heart disease as their primary discharge diagnosis have undergone troponin testing during hospitalisation. Aims:To determine associations between cardiac troponin levels and mortality, including from cardiovascular and non-cardiovascular causes, among patients hospitalised in New South Wales, Australia over a 2-year period.Methods: Over a 2-year period (2006)(2007)(2008), 172 753 hospitalised patients had a quantitative or qualitative troponin assay performed in New South Wales (Australia). The associations were examined, using data linked to late outcomes, between elevations in levels of troponins T or I and 1-year mortality. Mortality was determined for International Statistical Classification of Diseases 10th Revision diagnostic groups.Results: Of 172 753 patients undergoing troponin testing, 44 357 (25%) had a cardiovascular diagnosis of whom (7% had myocardial infarction) 47 827 (28%) had a probable ischaemic heart disease diagnosis if the 23 873 (14%) of patients coded with 'chest pain' were included. In patients with a cardiovascular diagnosis and elevated troponin 3060 (1.8%) died in 12 months in comparison to 6262 (3.6%) in those with a non-cardiovascular disease diagnoses and elevated troponin. The 1-year mortality hazard with respect to a troponin elevation was 2.5 (95% confidence interval 2.3-2.7) and 2.0 (95% confidence interval 1.99-2.01) for those with a cardiovascular and non-cardiovascular diagnosis respectively. Conclusion:In a very large state-wide hospitalised patient cohort, among patients with elevated troponin levels and non-cardiac diagnoses, mortality was higher than in those with cardiovascular diagnoses, including MI.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia

French

Brieger

Juergens

et al. 2020

Internal Medicine Journal

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“…6 Secondary prevention following an acute coronary syndrome is a challenging endeavour, with recurrent event rates unacceptably high in Australia. 7 We believe that the additional reduction in coronary events associated with increasing statin dose is comparable to combining other secondary prevention measures, as reported by Dimmitt and Martin, which justifies current guideline recommendations. 8…”

Section: Letterssupporting

confidence: 75%

Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis

Brieger

Weaver

Kritharides

2019

Medical Journal of Australia

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“…Triple vessel disease, stent implantation, hypertension, and eGFR or uric acid all contributed to the risk of a MACE between ACS and elective PCI patients. To the best of our knowledge, this study is the first observational clinical study to identify the independent risk factors for adverse cardiac events in a Chinese cohort of patients, who have distinct differences in presentation from those in western countries [17]. …”

Section: Discussionmentioning

confidence: 99%

The burden of major adverse cardiac events in patients with coronary artery disease

Tsai

Wang

et al. 2017

BMC Cardiovasc Disord

124

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BackgroundPatients with a history of cardiovascular disease are at high risk of developing secondary major adverse cardiac events (MACE). This study aimed to identify independent predictors of MACE after hospital admission which could be used to identify of high-risk patients who may benefit from preventive strategies.MethodsThis study included 1,520 consecutive patients with coronary artery disease (CAD) (654 with acute coronary syndrome (ACS) and 866 with elective percutaneous coronary intervention (PCI) patients) who received PCI and/or stenting. MACE was defined as all-cause mortality or rehospitalization for a cardiovascular- related illness. Cardiovascular-related illnesses included heart failure, reinfarction (nonfatal), recurrence of angina pectoris and repeat PCI or coronary artery bypass graft.ResultsDuring a mean follow-up period of 32 months, 558 of the 1,520 patients developed at least one MACE. Cox regression analysis showed that the baseline clinical and biochemical variables which associated with MACE were age, being illiterate, a widow or widower, and/or economically dependent, having triple vessel disease, stent implantation, anemia, and/or diabetes mellitus, waist to hip ratio (WHR), diastolic blood pressure, fasting glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), creatinine, estimated glomerular filtration rate (eGFR), red blood cell count, hemoglobin, hematocrit, and mean corpuscular-hemoglobin concentration (MCHC) in ACS patients, and age, malnourished, and/or economically dependent, taking hypoglycemic medication, having triple vessel disease, stent implantation, anemia, diabetes mellitus, and/or hypertension, WHR, fasting glucose, HDL-C, uric acid, creatinine, eGFR, high-sensitivity C-reactive protein, mean corpuscular volume, and MCHC in elective PCI patients. Using multivariate Cox regression analysis, we found the MACE’s independent factors are triple vessel disease, stent implantation, hypertension, and eGFR in ACS patients, and having triple vessel disease, stent implantation, hypertension, and uric acid in elective PCI patients.ConclusionsHaving triple vessel disease, stent implantation, hypertension, and eGFR or uric acid independently predicted MACE in patients with CAD after long-term follow-up. Fortunately, these factors are modifiable and should be identified and monitored early.

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Survival after an acute coronary syndrome: 18‐month outcomes from the Australian and New Zealand SNAPSHOT ACS study

Abstract: In Australia and New Zealand, the availability of a catheterisation laboratory appears to have a significant impact on long-term mortality in ACS patients, which is still substantial. This mortality may be reduced by improvements in evidence-based care in both CC and non-CC hospitals.

Cited by 26 publications

References 20 publications

Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia

Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia

Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis

The burden of major adverse cardiac events in patients with coronary artery disease

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