Background: Acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI), non-ST-segment myocardial infarction (NSTEMI) and unstable angina (UA). Although initially a syndrome with a poor prognosis, the advent of acute percutaneous coronary intervention (PCI), with novel stents and anticoagulation therapy, as
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Background: Acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI), non-ST-segment myocardial infarction (NSTEMI) and unstable angina (UA). Although initially a syndrome with a poor prognosis, the advent of acute percutaneous coronary intervention (PCI), with novel stents and anticoagulation therapy, as well as the establishment of acute chest pain units, has to a great extent improved the outcome for patients with ACS.
Objective: The aim of the present study was to assess the 30-day outcome for patients with ACS admitted to the University Hospital of Zurich, and to compare the data, particularly for in-hospital death, with results from various other registries, such as the international Global Registry of Acute Coronary Events (GRACE).
Methods: Between 2007 and 2010, we included consecutive patients with a diagnosis of ACS, examined in-hospital death and major adverse cardiac events (MACE) at 30-days, and compared our results with the esteemed GRACE-Registry.
Results: During these 4 years, 1,787 consecutive patients were diagnosed with ACS. Of these, 55.8% (n = 998) had STEMI, 35.3% (n = 631) NSTEMI and 8.8% (n = 158) UA. In contrast, in the GRACE, out of 11 543 patients 30% (n = 3419) had STEMI, 25% (n = 2893) NSTEMI and 38% (n = 4397) UA. The in-hospital death rate in our study group was 5.7% with STEMI, 2.5% with NSTEMI and 1.3% with UA (p = 0.001). Hospital case fatality rates for STEMI, NSTEMI and UA from the GRACE were 7%, 5% and 3%, respectively (p <0.01). At the University Hospital of Zurich, myocardial infarction occurred in 1.6%, 0.5% and 1.3% of the STEMI, NSTEMI and UA groups, respectively (p = 0.120), compared with 3% with STEMI and 2% with NSTEMI in the GRACE (data for UA not available). Cardiogenic shock was present in 8.7%, 5.4% and 0.6% (p <0.001) at the University Hospital of Zurich compared with 7%, 5%, and 2% (p <0.01) in patients from the GRACE for STEMI, NSTEMI and UA, respectively. Kaplan-Meier survival analysis including MACE revealed that patients with STEMI had the most unfavourable outcome when compared with NSTEMI and UA (p = 0.018).
Conclusions: Our results indicate that patients with ACS from the “real-world” Zurich registry show a higher rate of STEMI and yet lower event rates for adverse cardiovascular complications and in-hospital death when compared with the GRACE, which may be explained by the high standard of healthcare at this institution and implementation of novel therapeutic strategies.
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