Temporal trends in acute coronary syndrome by subtype

Abstract

Abstract Funding Acknowledgements None. Introduction Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU). Methods We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data. Results Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p<0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p<0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= <0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= <0.001). Conclusion We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.