Regular paperPrevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation
Section snippets
Patients:
We initiated a prospective study on July 1, 1997, to monitor the outcome of a radical shift from a noninvasive to an invasive strategy available 7 days/week, 24 hours/day in the management of patients with STEMI at Royal North Shore Hospital.3 The Interventional Cardiology Unit made the same immediate invasive strategy available to all patients with non–ST elevation acute coronary syndromes if symptoms and/or electrocardiographic abnormalities did not respond to anti-ischemic treatment within
Results
In the absence of prescriptive diagnostic criteria for suspected NSTEMI, the recruitment of patients increased as clinicians gained confidence in diagnosing AMI at the time of presentation on clinical grounds. Figure 1 shows the recruitment of 279 patients with STEMI and 125 with NSTEMI from July 1, 1997 to January 1, 2001. Elimination of age limits contributed to the increase in recruitment after the first year in both groups. The ratio of suspected NSTEMI/STEMI stabilized 2 years after the
Prevalence of NSTEMI:
We describe consecutive patients identified on presentation on the basis of electrocardiographic abnormalities, persistent symptoms, and/or hemodynamic instability. Only a high-risk subset of patients with non–ST-segment acute coronary syndromes is described. Patients believed to have unstable angina rather than infarction were not studied. Some with early resolution of clinical and electrocardiographic abnormalities were not included, even if they ultimately had a confirmed diagnosis of AMI.
Acknowledgements
We thank the staff in the Cardiac Catherization Laboratory, the Coronary Care and Intensive Care Units, and the Department of Cardiothoracic Surgery for their help in the care of patients in this study. We also thank our medical colleagues in the Departments of Cardiology and Emergency Medicine. Their clinical evaluation of patients and enthusiastic support for our infarct angioplasty program made this study possible. Finally, we thank Annie Loxton, BA, and Jacqueline Padley, RN, for their
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