Are patients with non-ST elevation myocardial infarction undertreated?
BACKGROUND
The worse prognosis in patients without ST-elevation (non-STEMI) as compared to ST-elevation myocardial infarction (STEMI), may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population.


METHODS
Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI.


RESULTS
A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation) were independent and significant predictors of long-term mortality.


CONCLUSIONS
In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive) treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.
Rasoul
Saman
S
Isala Klinieken, Dept of Cardiology, Zwolle, The Netherlands. s.rasoul@isala.nl <s.rasoul@isala.nl>
Ottervanger
Jan Paul
JP
Dambrink
Jan-Henk E
JH
de Boer
Menko-Jan
MJ
Hoorntje
Jan C A
JC
Gosselink
A T  Marcel
AT
Zijlstra
Felix
F
Suryapranata
Harry
H
van 't Hof
Arnoud W J
AW
D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002309:Cardiology / Q000706:statistics & numerical data*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D016019:Survival Analysis
D002317:Cardiovascular Agents