In-Hospital Invasive Strategy and Outcomes in Non-ST Elevation Acute Coronary Syndrome Management from Thai Acute Coronary Syndrome Registry
Arintaya Phrommintikul MD*, Srun Kuanprasert MD*, Thosapol Limpijankit MD**, Kriengkrai Hengrassamee MD***
Affiliation : * Cardiovascular Division, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai ** Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok *** Cardiology Unit, Department of Medicine, Chest Disease Institute, Nonthaburi
Background : The management guideline of acute coronary syndrome has been changed in recent years,
especially in the group of non-ST elevation acute coronary syndrome (NSTE-ACS). Presently, there is no
existing guideline in Thailand. Additionally, several different management factors of health care from Western
countries being used.
Objective : Evaluate the real management strategy, including the utilization of invasive management and
pharmacotherapy of NSTE-ACS Thai patients in the absence of official clinical management guideline.
Materials and Methods : Thai Acute Coronary Syndrome (Thai ACS) Registry is a large, observational prospec-
tive, population-based registry designed to collect the data of “real-life” patient management. The full details
of methods have been published in the present supplement.
Results : Five thousand five hundred and thirty-seven consecutive patients were registered between August 1,
2002 and July 31, 2005. Among these patients, 3,548 (64.1%) were diagnosed with non-ST elevation myocar-
dial infarction (NSTEMI) and 1,989 (35.9%) with unstable angina. Coronary angiography was performed
during hospitalization in 2,476 patients (44.7%). From 2,476 patients who underwent coronary angiogram,
405 (16.4%) had revascularization within 2 days and 1,019 (42.9%) after 2 days. Overall, in-hospital mortal-
ity was 9.5% and cardiac mortality was 6.3%. Patients with NSTEMI had more than 4 times the mortality of
patients with unstable angina (13.1 vs. 3.0%, p < 0.001). Patients who received only medical treatment
without coronary angiogram had the highest mortality rate. The in-hospital outcomes were not different
between patients who received early or delayed revascularization.
Conclusion : Mortality rate of NSTEACS in the authors’ registry was very high. NSTEMI had the worse
prognosis. Invasive strategy is associated with better in-hospital outcome but is underutilized.
Keywords : Non ST elevation acute coronary syndrome (NSTE-ACS), Non ST segment elevation myocardial infarction (NSTEMI), Unstable angina (UA)
