Article Text
Abstract
Objective Acute coronary syndromes (ACS) are common, but their incidence and outcome might depend greatly on how data are collected. We compared case ascertainment rates for ACS and myocardial infarction (MI) in a single institution using several different strategies.
Methods The Hull and East Yorkshire Hospitals serve a population of ∼560 000. Patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses during 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and, independently, from Myocardial Infarction National Audit Project (MINAP) records. The hospital laboratory identified all patients with an elevated serum troponin-T (TnT) by contemporary criteria (>0.03 µg/L in 2005).
Results The prospective survey identified 1731 admissions (1439 patients) with ACS, including 764 admissions (704 patients) with MIs. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to the MINAP. Using all 3 strategies, 934 admissions (873 patients) for MI were identified, for which TnT was >1 µg/L in 443, 0.04–1.0 µg/L in 435, ≤0.03 µg/L in 19 and not recorded in 37. A further 823 patients had TnT >0.03 µg/L, but did not have ACS ascertained by any survey method. Of the 873 patients with MI, 146 (16.7%) died during admission and 218 (25.0%) by 1 year, but ranging from 9% for patients enrolled in the MINAP to 27% for those identified by the hospital information department.
Conclusions MINAP and hospital statistics grossly underestimated the incidence of MI managed by our hospital. The 1-year mortality was highly dependent on the method of ascertainment.
- Myocardial infarction
- Mortality
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Footnotes
Contributors JGFC contributed to study design and wrote the manuscript. NS is responsible for making tables and data collection. PA involved in data collection. HP and KG contributed to statistics and tables. EK is responsible for providing some of the data. ST, AH, FA and ALC are responsible for finding patients and collecting data. AR is responsible for statistics and figures.
Funding This research was supported by an unrestricted grant from Pfizer. JGFC reports speaker's honoraria and research support from Roche Diagnostics.
Competing interests None declared.
Ethics approval Research and development Department of Hull and East Yorkshire.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.