Acute Coronary Syndromes: Clinical Characteristics, Management, and Outcomes at the American University of Beirut Medical Center, 2002–2005

OBJECTIVES: Data on acute coronary syndromes (ACS) in developing countries is scarce. In this report, we analyze the temporal trends in the management and outcomes of a large series of ACS patients hospitalized at the American University of Beirut Medical Center (AUBMC), a tertiary referral university hospital located in a middle income Middle Eastern developing country. METHODS: A total of 1025 consecutive patients hospitalized and discharged with the diagnosis of ACS were enrolled between 2002 and 2005. The utilization of evidence-based therapies and in-hospital outcomes were determined. RESULTS: The study enrolled 228 patients (22%) with ST-elevation myocardial infarction (STEMI), 275 patients (27%) with non-ST-elevation myocardial infarction (NSTEMI), and 522 patients (51%) with unstable angina. The STEMI group was younger and had a higher percentage of men. The utilization rates of coronary angiography and percutaneous coronary intervention (PCI) were highest in the STEMI group. Comparison to earlier ACS data (1997-1998) from the same hospital, showed an increase in the utilization of reperfusion therapy, coronary angioplasty, bypass surgery, aspirin, beta-blockers, angiotensin-converting enzymes (ACE), angiotensin receptor blockers (ARB), and statins over the past decade (P < .05). This was associated with a significant decrease in hospital mortality (13%-7.7%, P < .01). CONCLUSIONS: This study analyzes one of the largest series of ACS patients reported from a single center in a developing country. The utilization of evidence-based therapies in the management of ACS at AUBMC has improved significantly over the past decade with an associated decrease in hospital mortality.