Skip to main content
SpringerLink
Log in

Temporal trends in incidence and outcome of acute coronary syndrome

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

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 in-hospital 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Niska R, Bhuiya F, Xu J (2010) National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Rep 26:1–31

    Google Scholar 

  2. Szummer K, Wattentin L, Lindhagen L, Alfredsson J, Erlinge D, Held C, James S, Kellerth T, Lindahl B, Ravn-Fischer A, Rydberg E, Yndigegn T, Jernberg T (2018) Relations between implementation of new treatments and improved outcomes in patients with non-ST-elevation myocardial infarction during the last 20 years: experiences from SWEDEHEART registry 1995 to 2014. Eur Heart J 39(42):3766–3776. https://doi.org/10.1093/eurheartj/ehy554

    Article  PubMed  Google Scholar 

  3. Neumann JT, Twerenbold R, Ojeda F, Sorensen NA, Chapman AR, Shah ASV, Anand A, Boeddinghaus J, Nestelberger T, Badertscher P, Mokhtari A, Pickering JW, Troughton RW, Greenslade J, Parsonage W, Mueller-Hennessen M, Gori T, Jernberg T, Morris N, Liebetrau C, Hamm C, Katus HA, Munzel T, Landmesser U, Salomaa V, Iacoviello L, Ferrario MM, Giampaoli S, Kee F, Thorand B, Peters A, Borchini R, Jorgensen T, Soderberg S, Sans S, Tunstall-Pedoe H, Kuulasmaa K, Renne T, Lackner KJ, Worster A, Body R, Ekelund U, Kavsak PA, Keller T, Lindahl B, Wild P, Giannitsis E, Than M, Cullen LA, Mills NL, Mueller C, Zeller T, Westermann D, Blankenberg S (2019) Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med 380(26):2529–2540. https://doi.org/10.1056/NEJMoa1803377

    Article  CAS  PubMed  Google Scholar 

  4. Twerenbold R, Neumann JT, Sorensen NA, Ojeda F, Karakas M, Boeddinghaus J, Nestelberger T, Badertscher P, Rubini Gimenez M, Puelacher C, Wildi K, Kozhuharov N, Breitenbuecher D, Biskup E, de Lavallaz JF, Flores D, Wussler D, Miro O, Martin Sanchez FJ, Morawiec B, Parenica J, Geigy N, Keller DI, Zeller T, Reichlin T, Blankenberg S, Westermann D, Mueller C (2018) Prospective validation of the 0/1-h algorithm for early diagnosis of myocardial infarction. J Am Coll Cardiol 72(6):620–632. https://doi.org/10.1016/j.jacc.2018.05.040

    Article  PubMed  Google Scholar 

  5. Nabel EG, Braunwald E (2012) A tale of coronary artery disease and myocardial infarction. New Engl J Med 366(1):54–63. https://doi.org/10.1056/NEJMra1112570

    Article  CAS  PubMed  Google Scholar 

  6. Bestehorn K, Bauer T, Fleck E, Bestehorn M, Pauletzki J, Hamm C (2015) Coronary procedures in German hospitals: a detailed analysis for specific patient clusters. Clin Res Cardiol 104(7):555–565. https://doi.org/10.1007/s00392-015-0818-3

    Article  PubMed  Google Scholar 

  7. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, Brauer M, Kutty VR, Gupta R, Wielgosz A, AlHabib KF, Dans A, Lopez-Jaramillo P, Avezum A, Lanas F, Oguz A, Kruger IM, Diaz R, Yusoff K, Mony P, Chifamba J, Yeates K, Kelishadi R, Yusufali A, Khatib R, Rahman O, Zatonska K, Iqbal R, Wei L, Bo H, Rosengren A, Kaur M, Mohan V, Lear SA, Teo KK, Leong D, O'Donnell M, McKee M, Dagenais G (2019) Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. https://doi.org/10.1016/S0140-6736(19)32008-2

    Article  PubMed  Google Scholar 

  8. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T, Yu L, Zhang S, Mony P, Swaminathan S, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear S, Anand S, Wielgosz A, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Iqbal R, Rahman O, Rosengren A, Yusufali A, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Oguz A, McQueen M, McKee M, Dagenais G, Investigators P (2014) Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 371(9):818–827. https://doi.org/10.1056/NEJMoa1311890

    Article  CAS  PubMed  Google Scholar 

  9. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS (2010) Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 362(23):2155–2165. https://doi.org/10.1056/NEJMoa0908610

    Article  CAS  PubMed  Google Scholar 

  10. Krumholz HM, Normand ST, Wang Y (2019) Twenty-year trends in outcomes for older adults with acute myocardial infarction in the United States. JAMA Netw Open 2(3):e191938. https://doi.org/10.1001/jamanetworkopen.2019.1938

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alpert JS, Thygesen K, Antman E, Bassand JP (2000) Myocardial infarction redefined–a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36(3):959–969

    Article  CAS  Google Scholar 

  12. Westermann D, Neumann JT, Sorensen NA, Blankenberg S (2017) High-sensitivity assays for troponin in patients with cardiac disease. Nat Rev Cardiol 14(8):472–483. https://doi.org/10.1038/nrcardio.2017.48

    Article  CAS  PubMed  Google Scholar 

  13. Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E, Bickel C, Baldus S, Warnholtz A, Frohlich M, Sinning CR, Eleftheriadis MS, Wild PS, Schnabel RB, Lubos E, Jachmann N, Genth-Zotz S, Post F, Nicaud V, Tiret L, Lackner KJ, Munzel TF, Blankenberg S (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361(9):868–877. https://doi.org/10.1056/NEJMoa0903515

    Article  CAS  PubMed  Google Scholar 

  14. Keller T, Zeller T, Ojeda F, Tzikas S, Lillpopp L, Sinning C, Wild P, Genth-Zotz S, Warnholtz A, Giannitsis E, Mockel M, Bickel C, Peetz D, Lackner K, Baldus S, Munzel T, Blankenberg S (2011) Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction. JAMA 306(24):2684–2693. https://doi.org/10.1001/jama.2011.1896

    Article  CAS  PubMed  Google Scholar 

  15. Anand A, Shah ASV, Beshiri A, Jaffe AS, Mills NL (2019) Global adoption of high-sensitivity cardiac troponins and the universal definition of myocardial infarction. Clin Chem 65(3):484–489. https://doi.org/10.1373/clinchem.2018.298059

    Article  CAS  PubMed  Google Scholar 

  16. Jernberg T (2019) Swedeheart Annual Report for 2018.

  17. Bestehorn K, Bestehorn M, Fleck E, D`Ancona G, Ince H, Eggebrecht H (2019) Increase of in-hospital mortality of stemi-patients after pci? a risk adjusted analysis of German quality assurance data 2008–2013. J Cardiol Cardiovasc Ther. 13(3):555865. https://doi.org/10.19080/JOCCT.2019.13.555865

    Article  Google Scholar 

  18. Nagarajan V, Fonarow GC, Ju C, Pencina M, Laskey WK, Maddox TM, Hernandez A, Bhatt DL (2017) Seasonal and circadian variations of acute myocardial infarction: findings from the Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program. Am Heart J 189:85–93. https://doi.org/10.1016/j.ahj.2017.04.002

    Article  PubMed  Google Scholar 

  19. Mohammad MA, Koul S, Rylance R, Frobert O, Alfredsson J, Sahlen A, Witt N, Jernberg T, Muller J, Erlinge D (2018) Association of weather with day-to-day incidence of myocardial infarction: A SWEDEHEART Nationwide Observational Study. JAMA Cardiol 3(11):1081–1089. https://doi.org/10.1001/jamacardio.2018.3466

    Article  PubMed  PubMed Central  Google Scholar 

  20. Claeys MJ, Rajagopalan S, Nawrot TS, Brook RD (2017) Climate and environmental triggers of acute myocardial infarction. Eur Heart J 38(13):955–960. https://doi.org/10.1093/eurheartj/ehw151

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

J.N. was supported by a grant from the German Research Foundation, the German Heart Foundation/German Foundation of Heart Research, the Else Kröner Fresenius Stiftung and the DZHK; and is recipient of a research fellowship by the Deutsche Forschungsgemeinschaft (NE 2165/1-1).

Author information

Authors and Affiliations

  1. Department for Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Johannes T. Neumann, Alina Goßling, Nils A. Sörensen, Stefan Blankenberg, Christina Magnussen & Dirk Westermann

  2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany

    Johannes T. Neumann, Nils A. Sörensen, Stefan Blankenberg, Christina Magnussen & Dirk Westermann

Authors
  1. Johannes T. Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alina Goßling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nils A. Sörensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Blankenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Magnussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dirk Westermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes T. Neumann.

Ethics declarations

Conflict of interest

JN has received honoraria from Abbott Diagnostics, Siemens and Prevencio; SB has received honoraria from Abbott Diagnostics, Siemens, Thermo Fisher, and Roche Diagnostics and is a consultant for Thermo Fisher. DW reports personal fees from Bayer, Boehringer-Ingelheim, Berlin Chemie, Astra Zeneca, Biotronik and Novartis.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 38 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neumann, J.T., Goßling, A., Sörensen, N.A. et al. Temporal trends in incidence and outcome of acute coronary syndrome. Clin Res Cardiol 109, 1186–1192 (2020). https://doi.org/10.1007/s00392-020-01612-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-020-01612-1

Keywords

Search

Navigation