We aimed to investigate changes of incidence, outcome and related interventions of patients with acute coronary syndrome (ACS) over the past decade in Germany.
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.
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.
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 to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Niska R, Bhuiya F, Xu J (2010) National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Rep 26:1–31
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Jernberg T (2019) Swedeheart Annual Report for 2018.
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
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
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
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
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).
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.
About this article
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 (2020). https://doi.org/10.1007/s00392-020-01612-1
- Acute coronary syndrome
- Myocardial infarction
- Unstable angina pectoris
- In-hospital mortality