Prognosis

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Behandeling acuut coronair syndroom in een urgente situatie (in afwachting van hospitalisatie)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge du syndrome coronarien aigu (SCA) en situation d'urgence (en attente d'hospilatisation)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022

Patients who have experienced NSTEMI have a high risk of morbidity and death from a future event.[157]​ The rate of sudden death in patients who have had a myocardial infarction (MI) is 4 to 6 times the rate in the general population.[158] Data from the UK from 2007-2017 showed that in the 9 years following an acute MI, around one third of patients developed heart failure or renal failure, 7% had a further MI, and 38% died.[157]

Life-threatening ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation) occurring after 48 hours from the index acute coronary syndrome portend a poor prognosis, and are most frequently associated with left ventricular dysfunction. The benefit of implantable cardioverter-defibrillators, for both primary and secondary prevention, in patients with significant left ventricular dysfunction has been well demonstrated.[1][159][160] Implantation for primary prevention should be considered at around 40 days following hospital discharge based on current recommendations.[1][161]

This risk varies significantly and is widely dependent on patient characteristics and risk factors (diabetes or smoking), presence of heart failure, extent of infarction, treatment given (percutaneous coronary intervention or coronary artery bypass graft), and compliance with long-term treatment regimens (cardiac rehabilitation, lifestyle changes, and pharmacotherapy).[162]

Modern therapy for NSTEMI, particularly statins and revascularisation, has decreased morbidity and mortality by reducing the likelihood of cardiogenic shock, recurrent myocardial infarction, and death.[163][164]​​​​ Adherence to evidence-based medicine has been shown to have better patient outcomes.[163][165]​ The risk of hospitalisation for heart failure following an acute MI is higher in female patients than in males.[166]

Data from the era prior to medical therapy and revascularisation suggest that the risk of cardiovascular death following a myocardial infarction in the absence of treatment is approximately 5% per year, with a death rate after hospital discharge in the first year of about 10%. Pharmacotherapy, lifestyle changes, and cardiac rehabilitation are well demonstrated to be beneficial and together are additive in reducing mortality.[5][72][167][168]

Use of this content is subject to our disclaimer