Are patients with non-ST elevation myocardial infarction undertreated?

Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI.A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation) were independent and significant predictors of long-term mortality.In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive) treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.Myocardial infarction (MI) is usually categorized into non-ST-elevation myocardial infarction (non-STEMI) and ST-elevation myocardial infarction (STEMI). Patients with STEMI should be treated immediately with reperfusion therapy by either percutaneous coronary intervention (PCI) or thrombolysis, if admitted within 12 h of symptom onset [1-4]. Patients with non-STEMI should be stabilized medically and high-risk patients should be scheduled for an early (within days) interventional strategy [5,6].A previous study has shown that in unselected patients, mortality was significantly higher in the non-STEMI as compared to STEMI patients [7]. However, in that study coronary angiogr