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Introduction: Our purpose was to evaluate treatment and mortality in an unselected consecutive patient population hospitalised with definite acute coronary syndrome (ACS) in 2000 and 2003., Materials and Methods: From 1 September 2000 to 15 January 2001 and from 1 September 2003 to 15 January 2004, all patients hospitalised in the Department of Cardiology, Odense University Hospital, Denmark, with ACS were consecutively registered., Results: 396 patients with ACS were included, 200 in 2000 and 196 in 2003. Their mean age increased from 68 +/- 12.5 years in 2000 to 71 +/- 13.4 years in 2003, p = 0.03. The number of patients older than 75 years of age increased from 35% in 2000 to 44% in 2003, p < 0.001. The one-year mortality rate was 24% in 2000 and 22% in 2003. Cox regression analysis demonstrated that the risk of death was highest in older patients (RR 1.06, 95% CI 1.03-1.09, p < 0.001) adjusted for gender, type of myocardial infarction (MI) and previous MI. The mortality rate for patients < or = 75 years decreased from 2000 to 2003 during hospitalisation (5.3% vs. 4.6%), after 30 days (9.7% vs. 7.7%) and after 1 year (18.5% vs. 9.9%). From 2000 to 2003, a rise in invasive treatment strategy was observed, together with an increased use of statins and clopidogrel., Conclusion: Age is an independent predictor of mortality after ACS, and the age of patients hospitalised with ACS has increased. The one-year mortality rate is close to one fourth. For younger patients, the mortality rate has decreased. Compared to randomised clinical trials, a considerable discrepancy in mortality was observed, predominantly due to the restricted patient selection in such studies and the concomitant lack of representation of daily-life patients.

Introduction: During the ten-year period 1989 to 1998, all percutaneous coronary interventions (PCI) in Denmark were recorded in the Danish PTCA Registry. The purpose was quality control based on treatment activity, severity of illness, technique employed, success rate, and complications., Material and Methods: For each PCI procedure a number of 144 parameters were recorded in a national database. The present analysis of these data was carried out using parametric statistics and logistic regression analysis., Results: From 1989 to 1998 the annual number of PCI procedures increased from 240 to 3840. The database contains 13,868 procedures of which 10,804 are first time interventions. Men accounted for three fourths of the patients. The mean age was 60.7 years for women and 57.9 years for men. During the ten-year period a rise of two years on average was seen for both sexes with a doubling of patients being older than 70 years. More patients with acute coronary syndrome and multivessel disease had PCI. The use of coronary stents increased from 2.0% in 1992 to 90.7% in 1998 and the primary success rate rose from 81% to 90%. Serious complications decreased from 5.4% to 3.0%, mainly due to a significant fall in procedurally related acute bypass surgery. Mortality remained unchanged around 0.6%. Age was found to be the only independent predictor for major procedurally related complications., Discussion: From 1989 to 1998 a sixteenfold increase in the number of PCI was observed. In parallel to this was seen an increase in the use of coronary stents and in the procedural success rate, while the frequency of serious complications decreased. This progress is similar to that of several other European countries.

Lipid lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statins) may reduce morbidity and mortality in patients with stable ischaemic heart disease. In trials where a statin was used as secondary prevention after an acute coronary syndrome (ACS), the treatment was initiated 3-6 months after the event. A high rate of serious complications occurs in the unstable clinical state after an ACS, including myocardial infarction and death. The incidence rate of serious complications declines after 1 month and then gradually diminishes. It has not been determined whether initiation of treatment with a statin soon after an ACS reduces the occurrence of early coronary events. Statins have effects on the vessel wall other than the lipid lowering effect, and these may partly account for the benefit of statin therapy. Whether these mechanisms are associated with a prognostic effect soon after an ACS has not been clarified.