• Artur Dziewierz, Zbigniew Siudak, Dominika Dykla, Tomasz Rakowski, Waldemar Mielecki, Jacek S Dubiel, and Dariusz Dudek.
• Zakład Hemodynamiki i Angiokardiografii, Uniwersytet Jagielloński Collegium Medicum, ul. Kopernika 17, 31-501 Krakow, Poland. mcdudek@cyf-kr.edu.pl
• Kardiol Pol. 2009 Feb 1;67(2):115-20; discussion 121-2.

BackgroundAccording to the presenting electrocardiogram, acute myocardial infarction (MI) can by categorised generally as non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI).AimTo assess the impact of the different acute MI categories on in-hospital management and mortality in hospitals without on-site invasive facilities.MethodsWe identified 380 NSTEMI and 334 STEMI patients treated in the Malopolska Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Data concerning in-hospital management and mortality were assessed.ResultsPatients with NSTEMI were older and were more likely to have prior angina, prior MI and prior heart failure symptoms than STEMI patients. The NSTEMI patients were less likely to be transferred for invasive treatment (23.9 vs. 41.9%, p <0.0001) and receive glycoprotein IIb/IIIa inhibitors during index hospital stay. The use of low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II antagonists, nitrates and statins was more frequent in NSTEMI patients. Among patients treated non-invasively, in-hospital mortality was high, but was lower in NSTEMI than STEMI patients (12.1 vs. 22.7%, p <0.0001). Independent predictors of in-hospital death in this group were age, cardiogenic shock, chronic obstructive pulmonary disease, and STEMI.ConclusionsDespite current recommendations, NSTEMI patients are still less likely to be transferred for invasive treatment than STEMI patients. Among patients treated non-invasively during index hospital stay, NSTEMI is associated with more favourable prognosis than STEMI, but the risk of in-hospital death is high. The hospital network should implement more frequently the strategy of early and urgent invasive treatment of NSTEMI patients.

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