| ORIGINAL ARTICLE |
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| Year : 2007 | Volume
: 8
| Issue : 1 | Page : 10-16 |
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Are patients with Non-ST elevation myocardial infarction undertreated?
Saman Rasoul1, Jan Paul Ottervanger1, Jan-Henk E Dambrink1, Menko-Jan de Boer1, Jan CA Hoorntje1, AT Marcel Gosselink1, Felix Zijlstra2, Harry Suryapranata1, Arnoud WJ van't Hof1
1 Isala Klinieken, Dept of Cardiology, Zwolle, The Netherlands, Netherlands
2 University Medical Center Groningen, University of Groningen, The Netherlands, Netherlands
Correspondence Address:
Saman Rasoul
Isala Klinieken, Dept of Cardiology, Zwolle, The Netherlands
Netherlands
 Source of Support: None, Conflict of Interest: None  | Check |
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Background: The worse prognosis in patients without ST-elevation (non-STEMI) as compared to ST-elevation myocardial infarction (STEMI) may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population.
Methods: Individual patient data from all patients in our hospital with a discharge diagnosis of MI between January 2001 and January 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI.
Results: A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation) were independent and significant predictors of long-term mortality.
Conclusion : In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive) treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients. |
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