The progress in outcomes of the management of patients with non-ST-segment elevation myocardial infarction between...

Dynamic changes both in clinical profile and treatment strategy of non ST-segment elevation myocardial infarction (NSTEMI) patients have been observed recently. The exact impact of them on prognosis in a wide national population remains unclear.

To evaluate the impact of treatment advances between 2005 and 2014 on the outcomes of NSTEMI cases.

NSTEMI patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS) were included to the analysis. The mortality rate in a hospital observation as well as in 12-month follow-up was evaluated.

The frequency of diabetes, hypertension, prior coronary artery interventions (especially percutaneous coronary intervention) raised. A frequency of invasive procedures increased remarkably (coronary angiography from 35.8% to 90.7%; p < 0.05 and percutaneous coronary intervention from 25.7% to 63.6%; p < 0.05). The usage of P2Y12 - inhibitors raised substantially from 56% to 93%; p < 0.05. In-hospital mortality decreased by fifty percent (in women from 6.6% to 3.3%; p < 0.001 and in men from 4.9% to 2.5%; p < 0.001, respectively). Similarly, 12-month mortality decreased up to one third (in women from 21.6% to 15.1%; p < 0.001 and in men from 17.8% to 12.8%; p < 0.001, respectively). Invasive strategy appeared to be the strongest factor decreasing mortality. Into in-hospital observation it reduces triple mortality risk whereas in 12-month follow up twice. Using propensity score matching analysis the impact of the treatment improvements on relative risk reduction was estimated on over 60%.

In last decade the outcomes of NSTEMI in Poland improved substantially. The predominant impact on it had a routine invasive strategy.