Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK)

Aims To determine characteristics, outcomes, prognostic indicators and mana gement of patients with acute coronary syndromes without ST elevation. Methods and Results A prospective registry was carried out with follow-up f or 6 months after index hospital admission. A history of acute cardiac ches t pain was required plus ECG changes consistent with myocardial ischaemia a nd/or prior evidence of coronary heart disease. Patients with ST elevation or those receiving thrombolytic therapy were excluded. A total of 1046 pati ents were enrolled from 56 U.K. hospitals. The mean age was 66 +/- 12 years and 39% were female. The rate of death or non-fatal myocardial infarction at 6 months was 12.2% and of death, new myocardial infarction, refractory a ngina or readmission for unstable angina at 6 months was 30%. In a multivar iate analysis, patients >70 years had a threefold risk of death or new myoc ardial infarction compared with those <60 years (P<0.01) and those with ST depression or bundle branch block on the ECG had a five-fold greater risk t han those with normal ECG (P<0.001). Aspirin was given to 87% and heparin t o 72% of patients in hospital. At 6 months 56% received no lipid-lowering t herapy at all. The B-month rate of coronary angiography was 27% and any rev ascularization 15%. Conclusions In this cohort there was a one in eight chance of death or myoc ardial infarction, and a one in three chance of death, new myocardial infar ction, refractory angina or re-admission for unstable angina, over 6 months . Age and baseline ECG were useful markers of risk. Aspirin, heparin and st atins were not given to about one-sixth, one-third and one-half respectivel y. Rates of angiography and revascularization appear low. A review of treat ment strategies of unstable angina and myocardial infarction without ST ele vation is warranted in the U.K. to ensure that patients are receiving optim um treatments to reduce mortality and morbidity. (C) 2000 The European Soci ety of Cardiology.