Key result
Unstable angina shows no 10-year mortality difference versus STEMI despite lower in-hospital death.
Why the study?
Does unstable angina have a different 10-year mortality compared to NSTEMI and STEMI in patients presenting with acute coronary syndrome?
Cohort (n=3,029)
No
Does unstable angina have a different 10-year mortality compared to NSTEMI and STEMI in patients presenting with acute coronary syndrome?
Despite favorable acute stabilization and 0% in-hospital mortality, the survival advantage of unstable angina over STEMI attenuates over 10 years, highlighting the need for intensive secondary prevention.
Long-term mortality risk converges between unstable angina and STEMI despite acute differences; leaves open whether post-discharge strategies equalize outcomes.
Background and Objectives: Unstable angina has traditionally been considered the least severe acute coronary syndrome presentation, but ten-year prognostic data remain limited. We compared the clinical characteristics and ten-year prognosis of unstable angina versus non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction. Materials and Methods: This retrospective study included consecutive patients older than eighteen years admitted with suspected acute coronary syndrome to a Spanish tertiary hospital between January 2009 and December 2015. Ten-year survival and clinical outcomes were evaluated retrospectively through long-term tracking of electronic medical records and official regional death registries. Results: Of 3029 patients (10.6% with unstable angina, 45.0% with non-ST-segment elevation myocardial infarction, and 44.4% with ST-segment elevation myocardial infarction), those with unstable angina had a median age of 66.0 years (vs. 67.0 and 62.0 years in the other cohorts, respectively; p < 0.001) and a significantly higher prevalence of prior myocardial infarction (31.5% vs. 21.9% and 11.4%, respectively; p < 0.001). However, unstable angina presented lower-risk acute profiles (Killip class >I: 2.5% versus 17.5% and 20.7%; p < 0.001; median GRACE score: 89.9 versus 107.6 and 113.3; p < 0.001) and 0% in-hospital mortality (versus 3.3% and 5.4%; p < 0.001). At ten years, cumulative mortality reached 23.4% in unstable angina, converging with ST-segment elevation myocardial infarction (29.1%; p > 0.05) but remaining lower than non-ST-segment elevation myocardial infarction (35.3%; p < 0.05). In multivariable Cox analysis, unstable angina was not independently associated with ten-year mortality (overall p = 0.066; vs. STEMI p = 0.743; vs. NSTEMI p = 0.133). Conclusions: Despite favorable acute stabilization and the absence of in-hospital mortality, the survival advantage of unstable angina over ST-segment elevation myocardial infarction appears to attenuate over a ten-year period. This trend toward mortality convergence is likely associated with the baseline comorbidity burden, highlighting the clinical need for intensive secondary prevention.
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Romojaro-López et al. (2026) conducted a cohort in Acute coronary syndrome (n=3,029). Unstable angina vs. ST-segment elevation myocardial infarction (STEMI) was evaluated on All-cause mortality at 10 years (HR 1.048, 95% CI 0.791-1.389, p=0.743). Unstable angina was not independently associated with a difference in 10-year all-cause mortality compared to ST-segment elevation myocardial infarction (adjusted HR 1.048, p=0.743), despite lower in-hospital mortality.
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