ABSTRACT
Acute coronary syndrome (ACS) encompasses two major categories-ST
elevation myocardial infarction (STEMI) and non-ST elevation myocardial
infarction/unstable angina (NSTEMI/UA). Its treatment, patient demographics, and characteristics have evolved greatly in the past decades. According to the
National Registry of Myocardial Infarction (NRMI) database (1), from 1994
to 1999 the mean age of patients increased from 66.5 to 68.0 years, and the
proportion of female patients increased from 37.7% to 39.3%. Patients became
more obese, and the prevalence of traditional atherosclerosis risk factors, such
as diabetes, hypertension, and hypercholesterolemia, also increased. In the same
period of time, the prevalence of STEMI decreased from 36.4% to 27.1%, with
a concomitant rise of NSTEMI from 45% to 63%. However, due to the
implementation of published guidelines, the door-to-drug time for STEMI sig-
nificantly reduced from 47 minutes in 1994 to 38 minutes in 1999, with a signifi-
cant increase in the use of aspirin, beta-blockers, and angiotensin-converting
enzyme inhibitors (ACEI) during the first 24 hours after presentation. Overall,
these treatments led to a 48% reduction in hospital days, a 16% reduction of hos-
pital mortality (from 11.2% in 1990 to 9.4% in 1999), and varying degrees of
reduction of post-MI complications, such as ventricular tachycardia, reinfarction,
and cardiac rupture.
