The progress in outcomes of the management of patients with non-ST-segment elevation myocardial infarction between 2005 and 2014 in Poland - a propensity score matching analysis from the PL-ACS registry.

Introduction: Dynamic changes both in clinical profile and treatment strategy of non ST-segment elevation myocardial infarction (NSTEMI) patients have been observed recently. The exact impact of them on prognosis in a wide national population remains unclear.

Aim: To evaluate the impact of treatment advances between 2005 and 2014 on the outcomes of NSTEMI cases.

Material And Methods: NSTEMI patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS) were included to the analysis. The mortality rate in a hospital observation as well as in 12-month follow-up was evaluated.

Results: The frequency of diabetes, hypertension, prior coronary artery interventions (especially percutaneous coronary intervention) raised. A frequency of invasive procedures increased remarkably (coronary angiography from 35.8% to 90.7%; < 0.05 and percutaneous coronary intervention from 25.7% to 63.6%; < 0.05). The usage of P2Y12 - inhibitors raised substantially from 56% to 93%; < 0.05. In-hospital mortality decreased by fifty percent (in women from 6.6% to 3.3%; < 0.001 and in men from 4.9% to 2.5%; < 0.001, respectively). Similarly, 12-month mortality decreased up to one third (in women from 21.6% to 15.1%; < 0.001 and in men from 17.8% to 12.8%; < 0.001, respectively). Invasive strategy appeared to be the strongest factor decreasing mortality. Into in-hospital observation it reduces triple mortality risk whereas in 12-month follow up twice. Using propensity score matching analysis the impact of the treatment improvements on relative risk reduction was estimated on over 60%.

Conclusions: In last decade the outcomes of NSTEMI in Poland improved substantially. The predominant impact on it had a routine invasive strategy.