[Treatment and prognosis after acute coronary syndrome in an unselected patient population].
BACKGROUND
Our purpose was to evaluate treatment and mortality in an unselected consecutive patient population hospitalised with definite acute coronary syndrome (ACS) in 2000 and 2003.


METHODS
From 1 September 2000 to 15 January 2001 and from 1 September 2003 to 15 January 2004, all patients hospitalised in the Department of Cardiology, Odense University Hospital, Denmark, with ACS were consecutively registered.


RESULTS
396 patients with ACS were included, 200 in 2000 and 196 in 2003. Their mean age increased from 68 +/- 12.5 years in 2000 to 71 +/- 13.4 years in 2003, p = 0.03. The number of patients older than 75 years of age increased from 35% in 2000 to 44% in 2003, p < 0.001. The one-year mortality rate was 24% in 2000 and 22% in 2003. Cox regression analysis demonstrated that the risk of death was highest in older patients (RR 1.06, 95% CI 1.03-1.09, p < 0.001) adjusted for gender, type of myocardial infarction (MI) and previous MI. The mortality rate for patients < or = 75 years decreased from 2000 to 2003 during hospitalisation (5.3% vs. 4.6%), after 30 days (9.7% vs. 7.7%) and after 1 year (18.5% vs. 9.9%). From 2000 to 2003, a rise in invasive treatment strategy was observed, together with an increased use of statins and clopidogrel.


CONCLUSIONS
Age is an independent predictor of mortality after ACS, and the age of patients hospitalised with ACS has increased. The one-year mortality rate is close to one fourth. For younger patients, the mortality rate has decreased. Compared to randomised clinical trials, a considerable discrepancy in mortality was observed, predominantly due to the restricted patient selection in such studies and the concomitant lack of representation of daily-life patients.
Jensen
Lisette Okkels
LO
Odense Universitetshospital, Kardiologisk Afdeling. okkels@dadlnet.dk
Thayssen
Per
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D013577:Syndrome; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D010975:Platelet Aggregation Inhibitors