title: Temporal trends in the treatment and outcomes of patients With non-ST-segment elevation myocardial infarction in Poland from 2004-2010 (from the Polish Registry of Acute Coronary Syndromes).
abstract: The aim of this work was to analyze temporal trends in clinical presentation, treatment methods, and outcomes of patients in Poland with non-ST-segment elevation myocardial infarction (NSTEMI) from 2004 to 2010. A total of 90,153 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2004 to 2010 were analyzed. The main outcome measure was all-cause mortality after 12 months, identified from official mortality records. The percentage of admissions for NSTEMI among all acute coronary syndromes increased from 24% in 2004 to 38% in 2010 (p < 0.0001). From 2004 to 2010, the percentage of invasive treatment for NSTEMI increased significantly, almost threefold, to 83% (p < 0.0001). The frequency of recurrent myocardial infarction and stroke during hospitalization decreased significantly over the years, while the frequency of major bleeding increased. Twelve-month mortality decreased significantly throughout the time period, from 19.1% to 14.5%, but was stable in patients treated invasively and slightly higher in the last years in patients treated noninvasively. The invasive treatment of NSTEMI (relative risk 0.62, 95% confidence interval 0.57 to 0.67, p < 0.0001), together with the pharmacotherapy recommended by the guidelines, had a significant impact on reducing 12-month mortality in a multifactor analysis. In conclusion, the distinct improvement in the short- and long-term prognoses of patients with NSTEMI may be in part the result of the popularization of invasive treatment and the optimization of pharmacotherapy.
authors.affiliation: Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland. marek.gierlotka@sccs.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wilczek
authors.forename: Jarosław
authors.initials: J
authors.lastname: Wasilewski
authors.forename: Michał
authors.initials: M
authors.lastname: Hawranek
authors.forename: Mateusz
authors.initials: M
authors.lastname: Tajstra
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Osadnik
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D011044:Poland / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome