Patterns of presentation and outcomes of patients with acute coronary syndromes

Gjin Ndrepepa, Julinda Mehilli, Stefanie Schulz, Raisuke Iijima, Dritan Keta, Robert A Byrne, Jürgen Pache, Melchior Seyfarth, Albert Schömig, Adnan Kastrati
Cardiology 2009, 113 (3): 198-206

OBJECTIVES: We undertook this study to assess the relationship between presentation pattern and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention.

METHODS: This registry included 10,455 patients with ACS, of whom 2,853 patients had ST-segment elevation myocardial infarction(STEMI), 3,060 patients had non-ST-segment elevation myocardial infarction (NSTEMI) and 4,542 patients had unstable angina. The primary outcome was 1-year mortality.

RESULTS: At 1 year there were 976 deaths, 390 (13.7%) among STEMI patients, 366 (12.0%) among NSTEMI patients and 220 (4.8%) among patients with unstable angina (OR = 1.17, 95% CI 1.01-1.35 for STEMI vs. NSTEMI; OR = 3.00, 95% CI 2.56-3.51 for STEMI vs. unstable angina, and OR = 2.58, 95% CI 2.20-3.04 for NSTEMI vs. unstable angina). In the Cox proportional hazards model ACS form was an independent correlate of 1-year mortality (HR = 0.90, 95% CI 0.73-1.13 for STEMI vs. NSTEMI; HR = 1.56, 95% CI 1.13-2.14 for STEMI vs. unstable angina; HR = 1.72, 95% CI 1.30-2.29 for NSTEMI vs. unstable angina).

CONCLUSIONS: The presentation pattern affects 1-year mortality in patients with ACS, with unadjusted mortality being highest in patients with STEMI and lowest in patients with unstable angina.

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