Temporal trends in incidence and outcome of acute coronary syndrome
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ORIGINAL PAPER
Temporal trends in incidence and outcome of acute coronary syndrome Johannes T. Neumann1,2 · Alina Goßling1 · Nils A. Sörensen1,2 · Stefan Blankenberg1,2 · Christina Magnussen1,2 · Dirk Westermann1,2 Received: 14 November 2019 / Accepted: 29 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background We aimed to investigate changes of incidence, outcome and related interventions of patients with acute coronary syndrome (ACS) over the past decade in Germany. Methods Data on the international statistical classification of diseases and procedural codes from the Federal Bureau of Statistics in Germany was used. This included all ACS cases in Germany in the years 2005–2015. Analyses were performed separately for the diagnoses of overall ACS, ST-elevation myocardial infarction (MI), non-ST-elevation MI and unstable angina pectoris. Procedures including coronary angiography and percutaneous coronary intervention and the endpoint inhospital mortality were assessed. Results Between 2005 and 2015 a total of 3797,546 cases of ACS were recorded. The mean age was 69 years and 36% were females. In-hospital mortality was 6.3%, 62% underwent coronary angiography and 42% received percutaneous coronary intervention. In-hospital mortality was highest for patients with ST-elevation MI (12.0%) and lowest for patients with unstable angina pectoris (0.6%). From 2005 to 2015 the incidence rates of ACS, ST-elevation MI and unstable angina pectoris decreased, while the incidence rate of non-ST-elevation MI increased. The percentages of performed coronary angiographies and percutaneous coronary interventions increased from 52 to 70% and 34 to 50%, respectively. The adjusted incidence rate of in-hospital mortality decreased from 64.9 cases per 1000 person-years to 54.8 cases. Conclusion In a large dataset including more than 3.7 million cases, we report an increase in coronary procedures and a reduction of ACS incidence and related mortality in the past decade in Germany. Keywords Acute coronary syndrome · Myocardial infarction · STEMI · NSTEMI · Unstable angina pectoris · Outcome · In-hospital mortality · Trend · Germany
Introduction Patients presenting with suspected acute coronary syndrome (ACS) are an important population in emergency departments worldwide and account for more than 20 million Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01612-1) contains supplementary material, which is available to authorized users. * Johannes T. Neumann [email protected] 1
Department for Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
2
presentations to the emergency department in Europe and North America [1]. In the past decades, diagnostic and therapeutic pathways for these patients have substantially improved [2, 3]. This includes on the one hand faster and more accurate di
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