Despite advances in percutaneous coronary interventions (PCI), a subgroup of acute coronary syndrome (ACS) patients are still managed medically by a conservative approach. We sought to characterize a contemporary, large-scale, real-world cohort of ACS patients treated conservatively via pharmacological management, without PCI. Data was gathered from the ACS Israeli Survey (ACSIS) between 2000 and 2016, encompassing all consecutive patients admitted to cardiology wards with an ACS diagnosis. Included were 3,543 conservatively managed patients with non-ST elevation ACS (NSTE-ACS). Patients with ST elevation MI or those who underwent any coronary revascularization (PCI or bypass surgery) were excluded. Primary endpoints were 30-day major adverse cardiovascular events (MACE) and 1-year mortality. The study cohort was divided to 4 time-periods. Over 2 decades, medically managed NSTE-ACS patients remained of similar age (67 ± 13 years, p = 0.78), but had more atherosclerotic risk-factors and comorbidities. During time, patients were more often referred to diagnostic angiography and treated with statins, ACE-I/ARBs, and P2Y12 inhibitors (p < 0.001 for each). Over time, there were less in-hospital complications such as kidney injury and heart failure. The rate of 30-day MACE decreased (from 20.7% to 10.3%, earliest to latest period, p < 0.001). Compared with the earliest period, the latest period was associated with a reduction in 1-year mortality (14.7% to 11.6%; adjusted HR 0.65, 95% CI 0.47 to 0.90). In conclusion, Over 2 decades, in medically managed NSTE-ACS patients, short term prognosis has significantly improved while 1-year mortality demonstrated improvement only recently, likely due to incremental benefits of medical management.

尽管经皮冠状动脉介入治疗 (PCI) 取得了进展，但仍有一部分急性冠状动脉综合征 (ACS) 患者通过保守方法进行医学治疗。我们试图描述一个当代的、大规模的、真实的 ACS 患者队列，这些患者通过药物管理进行保守治疗，没有 PCI。数据来自 2000 年至 2016 年间的 ACS 以色列调查 (ACSIS)，包括所有连续入住心脏病病房并诊断为 ACS 的患者。包括 3,543 名保守治疗的非 ST 段抬高 ACS (NSTE-ACS) 患者。ST 段抬高 MI 或接受任何冠状动脉血运重建（PCI 或搭桥手术）的患者被排除在外。主要终点是 30 天主要不良心血管事件 (MACE) 和 1 年死亡率。研究队列被分成4个时间段。20 多年来，接受药物治疗的 NSTE-ACS 患者的年龄仍然相似（67 ± 13 岁，p = 0.78），但动脉粥样硬化危险因素和合并症更多。在此期间，患者更常被转诊至诊断性血管造影术并接受他汀类药物、ACE-I/ARB 和 P2Y12 抑制剂治疗（每种 p < 0.001）。随着时间的推移，肾损伤和心力衰竭等院内并发症较少。30 天 MACE 率下降（从 20.7% 到 10.3%，最早到最晚，p < 0.001）。与最早时期相比，最晚时期与 1 年死亡率降低相关（14.7% 至 11.6%；调整后 HR 0.65，95% CI 0.47 至 0.90）。总之，在过去的 20 年里，在医学管理的 NSTE-ACS 患者中，短期预后已显着改善，而 1 年死亡率仅在最近才有所改善，