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Influence of case definition on incidence and outcome of acute coronary syndromes

Torabi, Azam; Cleland, John G F; Sherwi, Nasser; Atkin, Paul; Panahi, Hossein; Kilpatrick, Eric; Thackray, Simon; Hoye, Angela; Alamgir, Farqad; Goode, Kevin; Clark, Andrew L; Rigby, Alan


Azam Torabi

John G F Cleland

Nasser Sherwi

Paul Atkin

Hossein Panahi

Eric Kilpatrick

Simon Thackray

Angela Hoye

Farqad Alamgir

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Dr Kevin Goode
Research Systems Project Manager / Business Analyst

Andrew L Clark


© 2016, BMJ Publishing Group. All rights reserved. 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.


Torabi, A., Cleland, J. G. F., Sherwi, N., Atkin, P., Panahi, H., Kilpatrick, E., Thackray, S., Hoye, A., Alamgir, F., Goode, K., Clark, A. L., & Rigby, A. (2016). Influence of case definition on incidence and outcome of acute coronary syndromes. Open heart, 3(2), e000487.

Journal Article Type Article
Acceptance Date Oct 18, 2016
Online Publication Date Dec 30, 2016
Publication Date 2016-12
Deposit Date Feb 21, 2017
Publicly Available Date Feb 21, 2017
Journal Open Heart
Electronic ISSN 2053-3624
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 3
Issue 2
Article Number e000487
Pages e000487
Keywords Myocardial infarction; Epidemiology
Public URL
Publisher URL
Additional Information This is a copy of an open access article published in Open Heart, 2016, v.2.
Contract Date Feb 21, 2017


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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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