Patients with acute coronary syndrome: Therapeutic management and one-yearprognosis in a tertiary hospital

Background. To assess the determinants of short-term and one-year prognosis of all patients with suspected acute coronary syndrome seen by the cardiol ogist on duty In the Emergency Service of a tertiary hospital during a six month period. Patients and methods. 153 consecutive patients with a diagnosis of acute my ocardial infarction, 225 with a diagnosis of unstable angina and 89 with a diagnosis of atypical chest pain were identified and their in-hospital char acteristics and one-year prognosis were prospectively assessed. Results. Age was higher than 65 years in 53% of acute myocardial infarction and in 54% of unstable angina patients. Only 3 patients were lost to follo wup. 35% of acute myocardial infarction patients had died or had reinfarcti on after one year and 16% of unstable angina patients had died or had suffe red acute myocardial infarction. Baseline features, management patterns and prognosis of patients admitted with acute myocardial infarction to the Car diology Service, to other hospital areas or to other hospitals were markedl y different, and admission in areas other than the Cardiology Service was a n independent mortality predictor. In unstable angina, complications happen ed in patients older than 75 years, those with previous revascularization p rocedures, those undergoing revascularization or those with lesions not dee med revascularizable. Conclusions. a) In the study population there was a predominance of elderly patients; the proportion of patients with poor prognosis was considerably high; b) a sizeable proportion of patients with severe complications was sc arcely represented in the major clinical trials; c) the possibility arises of a distribution of care resources tending to concentrate the greater ther apeutic efforts in the patients with good prognosis.