Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction☆
Introduction
Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent manifestation of acute coronary syndromes and presents with a wide range of symptoms [[1], [2]]. Diagnosis and management of acute coronary syndromes have rapidly evolved over the past two decades [3]. Although, several important advances in the management of NSTEMI have resulted in improved outcomes, the mortality is similar to that of patients with ST-segment elevation myocardial infarction after one year of acute event [4]. NSTEMI management has evolved considerably over time and part is due to successful results of several clinical trials proving efficacy and safety of early percutaneous coronary intervention (PCI) and medical therapy, which have led to rapid adaptation of contemporary pharmacological and invasive strategies in clinical guidelines, and consequently in clinical practice [3]. Recent reports have shown increased use of optimal pharmacotherapy and invasive approach, resulting in better outcomes such as improved early survival and decrease in morbidity in ACS patients [3,[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]]. However, these studies have been limited, including only selected populations or time-periods and often only short-term follow-up. Finally, little information on mortality and trends in cardiovascular events is available in NSTEMI patients [7,[13], [14], [15], [16]].
The present study aims to assess trends in mortality and cardiovascular events in consecutive patients with NSTEMI admitted in a tertiary single centre, assessing their clinical characteristics and management during admission between the years 2004 and 2015.
Section snippets
Study population
A retrospective study was conducted based on the CardioCHUS registry, which enrolled consecutive patients with NSTEMI diagnosis who were admitted in a cardiology unit at a tertiary hospital “University Clinical Hospital of Santiago de Compostela” in Spain, between November 2003 and December 2015 (n = 2952). Demographic, clinical, echocardiographic, coronary angiographic and laboratory data at admission was gathered and recorded in a computerized database, in accordance with the department's
Baseline characteristics
Between the years 2003 and 2015, 2951 patients with NSTEMI diagnosis were admitted, of whom 2608 (88.4%) were programmed for a coronary angiography during hospitalization, and of these 905 (34.7%) underwent early revascularization.
Table 1 shows the changes in clinical characteristics of NSTEMI patients over time. All groups had a similar mean age of 69 years [interquartile range (IQR) 59–78]; 28.8% were female, 31.1% were diabetic, and 24.1% had prior coronary artery disease. Over time,
Discussion
The present study is the first to address trends in a NSTEMI Spanish cohort regarding change in patient baseline characteristics, medical therapy, choice of invasive strategy, and mortality and morbidity outcomes, over the last decade. There has been an increasing administration of guideline-based pharmacotherapy with more implementation of early invasive coronary strategy, leading to a progressive decrease in outcomes, both in-hospital and in the follow-up. Although the improved outcomes could
Conclusion
Among patients hospitalized with NSTEMI, improvement in all-cause mortality and heart failure hospitalization was observed between 2003 and 2015. Adherence to guideline recommendations regarding optimal pharmacotherapy and early invasive strategies has been associated with better outcomes, reflecting the real-world quality of care in our NSTEMI Spanish population over time.
Conflict of interest
No conflict of interest.
References (29)
- et al.
A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: are non-ST myocardial infarctions associated with worse long-term prognoses?
Int. J. Cardiol.
(2011) - et al.
Trends in clinical trials of non-ST-segment elevation acute coronary syndromes over 15 years
Int. J. Cardiol.
(2013) - et al.
Temporal trends in the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction in Poland from 2004–2010 (from the Polish Registry of Acute Coronary Syndromes)
Am. J. Cardiol.
(2012) - et al.
The temporal trends of incidence, treatment, and in-hospital mortality of acute myocardial infarction over 15 years in a Taiwanese population
Int. J. Cardiol.
(2016) - et al.
Immediate versus delayed invasive intervention for non-STEMI patients
The RIDDLE-NSTEMI Study. JACC Cardiovasc Interv.
(2016) - et al.
Temporal trends in the use of early cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes (results from CRUSADE)
Am. J. Cardiol.
(2006) - et al.
On behalf of the DESCARTES study researchers. Management of non-ST-segment-elevation acute coronary syndromes in Spain. The DESCARTES study
Rev. Esp. Cardiol.
(2005) - et al.
Population-level changes to promote cardiovascular health
Eur. J. Prev. Cardiol.
(2013) - et al.
Heart disease and stroke statistics 2013 up-date: a report from the American Heart Association
Circulation
(2013) - et al.
ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)
Eur Heart J 2016; 37(3)
(2015)
Sex-stratified trends in enrollment, patients characteristics, treatment, and outcomes among non-ST-segment elevation acute coronary syndrome patients. Insights from clinical trials over 17 years
Circ. Cardiovasc. Qual. Outcomes
Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995–2014
Eur. Heart J.
Acute myocardial infarction: changes in patients characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-elevation Myocardial Infarction) 1995 to 2015
Circulation
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999–2010
J. Am. Heart Assoc. Cardiovasc. Cerebrovasc. Dis.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.