Influence of prior medication on mode of presentation and prognosis of acute coronary syndromes.
OBJECTIVE
To evaluate the influence of prior medication on mode of presentation and short-term prognosis of acute coronary syndromes (ACS).


METHODS
Prospective study.


METHODS
Coronary intensive care unit in Santa Cruz Hospital.


METHODS
We included 425 consecutive patients admitted for ACS.


METHODS
Prior medication with anti-platelet agents, beta-blockers, nitrates, calcium channel blockers, statins and angiotensin-converting enzyme (ACE) inhibitors was recorded on admission. Medication introduced in the last 7 days was excluded. Using a multivariate analysis model we examined the impact of baseline characteristics and previous medication on mode of presentation of ACS. We also evaluated their influence on short-term prognosis (death or non-fatal myocardial (re)infarction in the first 30 days).


RESULTS
Of the 425 patients studied 228 (53.6%) presented with unstable angina (UA), the remainder with acute myocardial infarction (AMI) (24.7% with ST elevation). Medication prior to admission included anti-platelet agents in 53.7% of patients, beta-blockers in 44.2%, nitrates in 48.2%, calcium channel blockers in 36.9%, statins in 28.9% and ACE inhibitors in 38.6%. During the first 30 days, 14 deaths (3.3%) and 37 (re)infarctions (8.7%) occurred. The combined occurrence of death or (re)infarction was 10.8%. Variables with significant and independent influence on mode of presentation of ACS were male gender, presence of known coronary artery disease and previous medication with anti-platelet agents and beta-blockers. Male gender was a predictor of AMI as mode of presentation, whereas a previous history of coronary artery disease and medication with anti-platelet agents or beta-blockers predicted UA. Short-term prognosis was influenced by heart failure symptoms on admission, but not by previous medication.


CONCLUSIONS
Previous medication with anti-platelet agents and beta-blockers was associated with an increased frequency of UA as mode of presentation of ACS. No relation between previous medication and short-term prognosis was observed in the present study.
Reis-Santos
Katya
K
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
Ferreira
Jorge
J
Aguiar
Carlos
C
Timóteo
Ana Teresa
AT
Ribeiro
Miguel Almeida
MA
Seabra-Gomes
Ricardo
R
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D013577:Syndrome
D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors