Management and mortality in patients with non-ST-segment elevation vs. ST-segment elevation myocardial infarction. Data from the Malopolska Registry of Acute Coronary Syndromes.
BACKGROUND
According to the presenting electrocardiogram, acute myocardial infarction (MI) can by categorised generally as non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI).


OBJECTIVE
To assess the impact of the different acute MI categories on in-hospital management and mortality in hospitals without on-site invasive facilities.


METHODS
We identified 380 NSTEMI and 334 STEMI patients treated in the Malopolska Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Data concerning in-hospital management and mortality were assessed.


RESULTS
Patients with NSTEMI were older and were more likely to have prior angina, prior MI and prior heart failure symptoms than STEMI patients. The NSTEMI patients were less likely to be transferred for invasive treatment (23.9 vs. 41.9%, p <0.0001) and receive glycoprotein IIb/IIIa inhibitors during index hospital stay. The use of low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II antagonists, nitrates and statins was more frequent in NSTEMI patients. Among patients treated non-invasively, in-hospital mortality was high, but was lower in NSTEMI than STEMI patients (12.1 vs. 22.7%, p <0.0001). Independent predictors of in-hospital death in this group were age, cardiogenic shock, chronic obstructive pulmonary disease, and STEMI.


CONCLUSIONS
Despite current recommendations, NSTEMI patients are still less likely to be transferred for invasive treatment than STEMI patients. Among patients treated non-invasively during index hospital stay, NSTEMI is associated with more favourable prognosis than STEMI, but the risk of in-hospital death is high. The hospital network should implement more frequently the strategy of early and urgent invasive treatment of NSTEMI patients.
Dziewierz
Artur
A
Zakład Hemodynamiki i Angiokardiografii, Uniwersytet Jagielloński Collegium Medicum, ul. Kopernika 17, 31-501 Krakow, Poland. mcdudek@cyf-kr.edu.pl
Siudak
Zbigniew
Z
Dykla
Dominika
D
Rakowski
Tomasz
T
Mielecki
Waldemar
W
Dubiel
Jacek S
JS
Dudek
Dariusz
D
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D012307:Risk Factors