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Characteristics, Treatment and In-hospital Outcomes of Unselected Patients with Non-ST-Elevation Myocardial Infarction in Daily Clinical Practice at An Interventional Centre over a Period of Ten Years: Results from the MIRLU-Registry

Spyridon Liosis, Steffen Schneider, Nicolas Werner, Sandra Tielke, Anselm Kai Gitt, Bernd Mark, Ralph Winkler, Caroline Kilkowski, Thomas Kleemann, Uwe Zeymer, Timm Bauer, Rudolf Schiele and Ralf Zahn

Background: Since the definition of Non-ST-Elevation Myocardial Infarction (NSTEMI) in 2000, its in-hospital management is rapidly developing. There is only a few available data, though, to describe the long-term changes in clinical characteristics, treatment patterns and outcomes in “real world” unselected patients and provide a feedback regarding guideline implementation.
Methods and results: We conducted a retrospective data collection of all consecutive patients admitted to our clinic with an acute myocardial infarction (AMI) between 2000 and 2009 (Myocardial Infarction Registry Ludwigshafen- MIRLU). From the overall 6119 patients included, 2976 were diagnosed with NSTEMI (48.6%). The median age was 67.9 ± 11.9 years and 68.5% were men. 93.4% underwent coronary angiography, 60.6% of them received percutaneous coronary intervention (PCI) and 4.8% immediate emergency bypass surgery. The rate of guideline adherent medical therapy was high at admission and at discharge. The most common in-hospital complications were post-infarction angina (4.4%), congestive heart failure (4.0%), cardiogenic shock (2.8%) and blood loss requiring transfusion (2.8%). Average in-hospital mortality was 4.2%. Over the period of ten years we observed an increase of 4.4 years in mean age (p for trend <0.01) and no changes in gender proportion (p=0.25). The rates of coronary angiography, PCI and stent implantation increased, while emergency bypass surgery rate declined (p<0.01). The complications’ rate remained unchanged (p=0.13). In-hospital mortality showed no significant variation (p=0.71). In a multivariate analysis cardiogenic shock, moderately and severely impaired left ventricular function and increasing age were independent mortality predictors.
Conclusion: The observation of NSTEMI patients over 10 years showed an increase in mean age, rates of coronary angiography and PCI with stent implantation, while emergency bypass surgery declined. Administration rate of guideline adherent medical therapy was high. However, overall mortality remained unchanged. Cardiogenic shock, significantly reduced left ventricular function and increasing age were the strongest predictors of in-hospital mortality.