Key result
In a registry of 1,804 ACS patients, in-hospital mortality was 10.9% for STEMI, 6.2% for NSTE-MI, and 1.2% for unstable angina, despite high rates of guideline-recommended revascularization.
Why the study?
Managing ACS in an ageing population with comorbidities is clinically and economically challenging, and unselected registries are needed to provide information on real-world clinical practice.
Observational (n=1,804)
No
Despite high rates of guideline-recommended revascularization, real-world in-hospital mortality for ACS remains significant, with NSTE-MI driving the highest hospital costs and longest stays.
Persistent high STEMI mortality signals need for improved therapies; confirms ACS subtype risk differences in contemporary practice.
Managing patients with acute coronary syndrome (ACS) in an ageing population with comorbidities is clinically and economically challenging. Well-conducted unselected registries are essential for providing information on real-day clinical practice. The aim was to create a long term, very detail-controlled registry of unselected patients admitted with ACS to a high-volume centre in Central Europe. Consecutive patients admitted with confirmed ACS were entered into the prospective registry from 1 October 2018 to 30 September 2021. Data on 214 parameters, including clinical characteristics, angiographic findings, laboratory and therapeutic findings, financial costs, and in-hospital mortality, were obtained for all patients. Analyses were performed on the complete dataset of 1804 patients. Of these patients, 694 (38.5%) were admitted for ST-segment elevation myocardial infarction (STEMI) and 1110 (61.5%) were admitted for non-ST-elevation (NSTE)-ACS [779 with NSTE myocardial infarction (NSTE-MI) and 331 with unstable angina (UA)]. Almost all patients (99%) underwent coronary angiography. Primary percutaneous coronary intervention (PCI) was performed in 93.4% of STEMI patients and 74.5% of NSTE-ACS patients. Patients with NSTE-MI had the longest total hospital stay (8.1 ± 9.1 days) and highest financial costs (8579.5 ± 7173.2 euros). In-hospital mortality was 1.2% in UA, 6.2% in NSTE-MI, and 10.9% in STEMI patients. Age older than 75 years, pre-hospital cardiac arrest and/or mechanical ventilation, subacute STEMI, and ejection fraction below 40% were the most powerful predictors of in-hospital mortality as assessed by multivariate analyses. The in-hospital mortality of unselected NSTE-MI and STEMI patients in daily practice is not low despite very good implementation of guideline-recommended therapy with a high rate of revascularization. The highest financial costs are associated with NSTE-MI.
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Toušek et al. (2022) conducted an observational in Acute coronary syndrome (n=1,804). Acute coronary syndrome was evaluated on In-hospital mortality. In a registry of 1,804 ACS patients, in-hospital mortality was 10.9% for STEMI, 6.2% for NSTE-MI, and 1.2% for unstable angina, despite high rates of guideline-recommended revascularization.
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