Acute coronary syndrome without persistent ST segment elevation in the emergency department: Epidemiology, clinical...

Acute coronary syndrome without persistent ST segment elevation (NSTE-ACS) is a major public health problem. It has been the subject of numerous studies but little has been published from the emergency department (ED).

Describe the epidemiology, clinical features, management and prognosis of patients with NSTE-ACS presenting to ED.

Prospective, observational, over four years study (2011-2015).

patients (> 18 years of age) presenting consecutively to ED with the diagnosis of NSTE-ACS. Collection of epidemiological, clinical and therapeutic features. Calculation of ischemic risk (TIMI and GRACE) and bleeding risk (CRUSADE) score. Prognosis (death and ischemic events) was evaluated at six months.  Results: Inclusion of 390 patients. Mean age = 61 ± 11 years. Sex-ratio = 1.46. Cardio-vascular risk factors (%):  hypertension (60), Mellitus diabetes (47), dyslipidemia (29) and smoking (26).   The median TIMI and GRACE scores were equal to 3 and 112 respectively. The median CRUSADE score was 29. Electrocardiographic findings (%): ST segment depression (43), T wave depression (24) and no ischemic changes (26).Initial management in the ED (%):  anti-ischaemic agents (43), antiplatelet agents (Acetylsalicylic acid (90), Clopidogrel (70)) and anticoagulants (70). Coronary angiography was done in all patients: early in 71% of patients and elective in 29% of patients.Prognosis at 6 months (%): recurrence of angina (24), infraction (9) and mortality (5).

Patients with NSTE-ACS are predominantly male. The main risk factors are hypertension, mellitus diabetes and dyslipidemia. The prognosis was good with a mortality rate of 5%.