Early clinical outcomes and routine management of patients with non-ST-segment elevation myocardial infarction - A nationwide perspective

Background: Myocardial infarction (MI) in the absence of electrocardiograph ic ST-segment elevation or new bundle branch block is the cause of hospital ization for a large and steadily increasing proportion of patients with acu te ischemic chest pain. Despite its prevalence, the common demographic feat ures, current hospital-based management, and short-term clinical outcome am ong patients with non-ST-segment elevation MI remain poorly defined. Methods: A total of 183113 patients with non-ST-segment elevation MI were i dentified in the National Registry of Myocardial Infarction database. Using a validated model, 43 928 patients (24.0%) were retrospectively placed in major, 34917 (19.1%) in intermediate, and 104 268 (56.9%) in minor severity clinical event categories that included hospital death, recurrent myocardi al ischemia, and nonfatal recurrent MI. Results: The administration of widely available and universally recommended pharmacologic therapies, including aspirin and beta -adrenergic blocking a gents, was suboptimal, particularly among patients with major severity clin ical events. In contrast, coronary angiography and mechanical revasculariza tion procedures were commonplace (>60% of all patients) and most frequently performed in patients within the minor (compared with the major) severity clinical event category (58.2% and 42.7%, respectively). Conclusions: Patients with non-ST-segment elevation MI are a heterogeneous population, with readily identifiable demographic characteristics and clini cal features associated with important early outcomes, including death. Nat ionwide efforts directed toward maximizing pharmacologic therapy utilizatio n and the performance of invasive procedures according to established guide lines must continue.