Acute coronary syndrome without persistent ST segment elevation in the emergency department: Epidemiology, clinical features and prognosis.

BACKGROUND: Acute coronary syndrome without persistent ST segment elevation (NSTE-ACS) is a major public health problem. It has been the subject of numerous studies but little has been published from the emergency department (ED).

OBJECTIVE: Describe the epidemiology, clinical features, management and prognosis of patients with NSTE-ACS presenting to ED.

METHODS: Prospective, observational, over four years study (2011-2015).

INCLUSION CRITERIA: patients (> 18 years of age) presenting consecutively to ED with the diagnosis of NSTE-ACS. Collection of epidemiological, clinical and therapeutic features. Calculation of ischemic risk (TIMI and GRACE) and bleeding risk (CRUSADE) score. Prognosis (death and ischemic events) was evaluated at six months.  Results: Inclusion of 390 patients. Mean age = 61 ± 11 years. Sex-ratio = 1.46. Cardio-vascular risk factors (%):  hypertension (60), Mellitus diabetes (47), dyslipidemia (29) and smoking (26).   The median TIMI and GRACE scores were equal to 3 and 112 respectively. The median CRUSADE score was 29. Electrocardiographic findings (%): ST segment depression (43), T wave depression (24) and no ischemic changes (26).Initial management in the ED (%):  anti-ischaemic agents (43), antiplatelet agents (Acetylsalicylic acid (90), Clopidogrel (70)) and anticoagulants (70). Coronary angiography was done in all patients: early in 71% of patients and elective in 29% of patients.Prognosis at 6 months (%): recurrence of angina (24), infraction (9) and mortality (5).

CONCLUSION: Patients with NSTE-ACS are predominantly male. The main risk factors are hypertension, mellitus diabetes and dyslipidemia. The prognosis was good with a mortality rate of 5%.