Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention

The management of patients with acute coronary syndrome who are hospitalized in non-cardiology clinics can be more challenging compared to those admitted directly to the emergency department or coronary intensive care unit. The aim of this study was to investigate the predictors of in-hospital mortality in patients with acute coronary syndrome who were initially hospitalized in non-cardiology clinics, and to compare outcomes between those managed with medical therapy alone versus those who also underwent percutaneous coronary intervention. This was a retrospective study. We enrolled patients who were referred as acute coronary syndrome from non-cardiology clinics (excluding patients with ST elevation myocardial infarction) between January 2018 and December 2023. Patients were divided into two groups based on their management approach: those who received medical therapy only and those who also underwent coronary angiography. Independent predictors of in-hospital mortality were identified using binary logistic regression analysis. A total of 241 patients were included in this study. While 112 patients (46.4%) received medical therapy only (Group 1), 129 patients (53.6%) underwent coronary angiography (Group 2), and 69 of 129 patients underwent percutaneous coronary intervention. The subgroup analysis showed that patients receiving medical therapy from the onset after coronary angiography (CAG) had a higher in-hospital mortality rate (32 of 172 patients, 18.6%) than those undergoing percutaneous coronary intervention (PCI) (10 of 69 patients, 14.4%), with a p-value of 0.040. We found that while advanced age, low serum albumin, elevated bilirubin, blood urea nitrogen, and cardiac troponin levels, as well as COVID-19 infection were associated with increased in-hospital mortality; percutaneous coronary intervention was associated with reduced in-hospital mortality in patients with acute coronary syndrome who were referred from non-cardiology clinics.