High mortality rates in conservatively managed patients with acute coronary syndrome.
OBJECTIVE
The revised diagnostic criteria for the acute coronary syndrome (ACS) have created the need for accurate and representative data on treatment and outcome for the three categories of ACS.


METHODS
Consecutive patients admitted with a suspected ACS (n = 755) from February 1, 2003 to January 31, 2004 was registered and categorised into five diagnostic groups: 1) ST-elevation myocardial infarction (STEMI) (n = 126), 2) Non-ST-elevation myocardial infarction (NSTEMI) (n = 185), 3) Unstable angina pectoris (UAP) (n = 55), 4) Coronary heart disease (CHD) without ACS (n = 164) and 5) Non-coronary chest pain (n = 225).


RESULTS
All-cause one-year mortality rates were 20%, 32%, 7%, 10% and 3%, in patients with STEMI, NSTEMI, UAP, CHD without ACS and non-coronary chest pain, respectively. In patients with STEMI, 61% received immediate reperfusion therapy (ratio thrombolysis: primary PCI = 18:1). Only 3% of those with NSTEMI had PCI within two days.


CONCLUSIONS
In this conservatively managed population of consecutive patients with ACS, the one-year mortality rate is significantly higher than seen in most registries and clinical trials.
Aune
Erlend
E
Department of Cardiology, Vestfold Hospital, Tønsberg, Norway. erlend.aune@siv.no
Hjelmesaeth
Jøran
J
Fox
Keith A A
KA
Endresen
Knut
K
Otterstad
Jan Erik
JE
D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D015425:Myocardial Reperfusion; D011446:Prospective Studies