In-hospital invasive strategy and outcomes in non-ST elevation acute coronary syndrome management from Thai Acute Coronary Syndrome Registry.
BACKGROUND
The management guideline of acute coronary syndrome has been changed in recent years, especially in the group of non-ST elevation acute coronary syndrome (NSTE-ACS). Presently, there is no existing guideline in Thailand. Additionally, several different management factors of health care from Western countries being used.


OBJECTIVE
Evaluate the real management strategy, including the utilization of invasive management and pharmacotherapy of NSTE-ACS Thai patients in the absence of official clinical management guideline.


METHODS
Thai Acute Coronary Syndrome (Thai ACS) Registry is a large, observational prospective, population-based registry designed to collect the data of "real-life" patient management. The full details of methods have been published in the present supplement.


RESULTS
Five thousand five hundred and thirty-seven consecutive patients were registered between August 1, 2002 and July 31, 2005. Among these patients, 3,548 (64.1%) were diagnosed with non-ST elevation myocardial infarction (NSTEMI) and 1,989 (35.9%) with unstable angina. Coronary angiography was performed during hospitalization in 2,476 patients (44.7%). From 2,476 patients who underwent coronary angiogram, 405 (16.4%) had revascularization within 2 days and 1,019 (42.9%) after 2 days. Overall, in-hospital mortality was 9.5% and cardiac mortality was 6.3%. Patients with NSTEMI had more than 4 times the mortality of patients with unstable angina (13.1 vs. 3.0%, p < 0.001). Patients who received only medical treatment without coronary angiogram had the highest mortality rate. The in-hospital outcomes were not different between patients who received early or delayed revascularization.


CONCLUSIONS
Mortality rate of NSTEACS in the authors' registry was very high. NSTEMI had the worse prognosis. Invasive strategy is associated with better in-hospital outcome but is underutilized.
Phrommintikul
Arintaya
A
Cardiovascular Division, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. apromint@mail.med.cmu.ac.th
Kuanprasert
Srun
S
Limpijankit
Thosapol
T
Hengrassamee
Kriengkrai
K
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009204:Myocardial Revascularization; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D013785:Thailand; D016896:Treatment Outcome