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The incidence and mortality due to acute coronary syndrome (ACS) among the German population has fallen over the decade since 2005, according to a Late-Breaking Science study reported yesterday by Doctor Johannes Neumann (University Heart Center Hamburg, Hamburg, Germany) (Abstract 1396).
The study involved every hospital in Germany and included all 3,797,546 cases of ACS reported throughout the country between 2005 and 2015. Dr. Neumann explains, “Over recent decades, the management of patients with ACS has changed substantially. Today, we have better primary and secondary prevention strategies, as well as interventional techniques, compared with 2005. It is important to know what effects these improved approaches have had on preventing and treating acute events.”
Between 2005 and 2015, incidence rates (per 1,000 person-years) fell for ACS (from 6.9 to 5.0 cases), ST-elevation myocardial infarction (STEMI) (from 2.0 to 1.0 cases) and unstable angina pectoris (from 2.7 to 1.5), although they increased for non-STEMI (from 1.8 to 2.5).
Over the whole period, around two-thirds of patients (62%) underwent coronary angiography and 42% received percutaneous coronary intervention (PCI). Between 2005 and 2015, the proportion of these procedures increased, by 35% for coronary angiography (representing an increase from 52% to 70%) and by 47% (an increase from 34% to 50%) for PCI.
Throughout the 10-year period, the in-hospital mortality was 6.3%, being highest for patients with STEMI (12%) and lowest for patients with unstable angina pectoris (0.6%).
Between 2005 and 2015, in-hospital mortality decreased from 64.4 to 59.3 cases per 1,000 person-years.
“The data suggest that improvements in diagnosis and secondary prevention have led to fewer people presenting with ACS,” says Dr. Neumann. “The reduction in in-hospital deaths we saw during this 10-year period is probably linked to the substantial increase in imaging and interventions we observed over the same time.” How do these data compare with the rest of Europe? “We are not aware of any similar data from other countries at this time,” he says, “but we would expect to see the same sort of trend. However, the results will depend on management approaches in each country. We know that in Germany, the use of coronary interventions is high, but this will differ between countries.”
It is not all good news, however, particularly for the 36% of patients who were women. “We saw substantial differences in treatment and outcomes between men and women, with fewer women receiving coronary angiography and PCI and a greater proportion dying in hospital,” says Dr. Neumann. “The fact that women were older when they received their first diagnosis may go some way to explaining these differences. It may also be because they more often present with atypical symptoms, which may lead to a delay in diagnosis and treatment. Further studies are warranted to understand sex differences and how imbalances can be addressed.”
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