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A Consecutive Series of all Subtypes of the Acute Coronary Syndrome Patient Admitted to an Academic Coronary Care Unit

Anne-lee J. Hoorweg, Maik J.D. Grundeken, Tim P. van de Hoef, Jose P.S. Henriques, Ron J.G. Peters, Jan J. Piek, Robbert J. de Winter, Jan Baan, Karel T. Koch, Joanna J. Wykrzykowska and Marije M. Vis

Objective: Little is known of the in-hospital management and outcomes of consecutive acute coronary syndrome (ACS) patients admitted to an academic coronary care unit (CCU). We therefore surveyed the characteristics, inhospital management and complications in an unselected ACS cohort.

Methods and results: In this retrospective observational cohort study we analyzed 567 consecutive ACS patients, divided in subgroups of ST-segment elevation myocardial infarction (STEMI) (n=369), non-STEMI (NSTEMI) (n=129) and unstable angina (UA) (n=69), admitted to our CCU. An invasive strategy was chosen in 93.8% of ACS patients (STEMI 98.1%, NSTEMI 85.3%, UA 87.0%, p<0.001). NSTEMI patients with a GRACE risk score>140 compared to ≤ 140 were less frequently treated with percutaneous coronary intervention (PCI) (50.0% vs. 70.2%, p=0.024) and more frequently with coronary artery bypass grafting (CABG) (20.5% vs. 3.6%, p=0.002). Overall in-hospital mortality was 3.2% (1.8% at discharge from the CCU). Thirty-day and one-year mortality were 4.9% and 8.5% respectively. In-hospital (re)infarctions occurred in 1.8%, stroke in 1.6% and major bleeding in 3.4% of patients. Major adverse cardiac and cerebrovascular events (MACCE) occurred in 4.9% and net adverse clinical events (NACE) in 6.9%. Age, female gender, previous stroke and chronic kidney disease (CKD) were associated with higher one-year mortality.

Conclusion: Our consecutive and unselected ACS cohort comprised 65.1% STEMI, 22.8% NSTEMI and 12.2% UA patients. Independent of ACS subtype and GRACE risk score about 90% of patients were treated by an invasive strategy. Age, female gender, previous stroke and CKD were associated with higher one-year mortality.