Demographics, treatment and outcome of acute coronary syndromes: 17 years of experience in a specialized cardiac centre.
BACKGROUND
Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited.


OBJECTIVE
To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period.


METHODS
A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed.


RESULTS
From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7.5 to 3.5 days. The mean age increased from 58.4 to 63.4 years, and the proportion of men remained stable at approximately 70%. The use of coronary angiograms increased from 49.8% to 81.1% in all patients, while fibrinolysis dropped to 0.4%. In-hospital mortality decreased from 9% to 1.5%. The percentage of overall instrumentation (arterial line, central venous catheter, temporary pacemaker, Swan-Ganz catheter and intra-aortic balloon pump) decreased from 38% to 8.1%. From 1995 to 2003, the proportion of stenting during percutaneous transluminal coronary angioplasty increased dramatically from 0% to 86%. In the past five years, surgical revascularization has remained stable at approximately 20% of all admissions. The proportion of patients discharged with a noncoronary chest pain diagnosis has remained constant at approximately 4%.


CONCLUSIONS
There has been a tremendous increase in efficiency, with an approximate doubling of the admissions turnover rate in a tertiary CCU. Patients with acute coronary syndromes are stratified faster and treated more invasively. Therapeutic advances are reflected by an almost linear 0.5% per year decrease in in-hospital mortality.
Research Centre, Montreal Heart Institute, and Department of Medicine, University of Montreal, Quebec, Canada.
Jean-Pierre S
JP
Awaida
Jocelyn
J
Dupuis
Pierre
P
Théroux
Guy
G
Pelletier
Michel
M
Joyal
Pierre
P
De Guise
Serge
S
Doucet
Luc
L
Bilodeau
Bernard
B
Thibault
Jean-Francois
JF
Tanguay
Richard
R
Gallo
Jean
J
Grégoire
Philippe L
PL
L'Allier
Laurent
L
Macle
Anil
A
Nigam
D017677:Age Distribution; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002548:Cerebral Revascularization / Q000706:statistics & numerical data; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology* / Q000628:therapy*; D003710:Demography; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data; D016896:Treatment Outcome