Key result
One-year all-cause mortality in conservatively managed patients was 20% for STEMI, 32% for NSTEMI, 7% for unstable angina, 10% for CHD without ACS, and 3% for non-coronary chest pain.
Observational (n=755)
Conservatively managed patients with acute coronary syndrome, particularly those with NSTEMI, experience high one-year mortality rates, emphasizing the potential need for more aggressive treatment strategies.
High mortality under conservative ACS management warrants caution in NSTEMI; leaves open whether revascularization improves survival in randomized trials.
OBJECTIVES: The revised diagnostic criteria for the acute coronary syndrome (ACS) have created the need for accurate and representative data on treatment and outcome for the three categories of ACS. DESIGN: Consecutive patients admitted with a suspected ACS (n = 755) from February 1, 2003 to January 31, 2004 was registered and categorised into five diagnostic groups: 1) ST-elevation myocardial infarction (STEMI) (n = 126), 2) Non-ST-elevation myocardial infarction (NSTEMI) (n = 185), 3) Unstable angina pectoris (UAP) (n = 55), 4) Coronary heart disease (CHD) without ACS (n = 164) and 5) Non-coronary chest pain (n = 225). RESULTS: All-cause one-year mortality rates were 20%, 32%, 7%, 10% and 3%, in patients with STEMI, NSTEMI, UAP, CHD without ACS and non-coronary chest pain, respectively. In patients with STEMI, 61% received immediate reperfusion therapy (ratio thrombolysis: primary PCI = 18:1). Only 3% of those with NSTEMI had PCI within two days. CONCLUSION: In this conservatively managed population of consecutive patients with ACS, the one-year mortality rate is significantly higher than seen in most registries and clinical trials.
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Aune et al. (2006) conducted an observational in Suspected acute coronary syndrome (n=755). Acute coronary syndrome diagnostic categories vs. Non-coronary chest pain was evaluated on All-cause one-year mortality. One-year all-cause mortality in conservatively managed patients was 20% for STEMI, 32% for NSTEMI, 7% for unstable angina, 10% for CHD without ACS, and 3% for non-coronary chest pain.
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