A Moroccan Experience in the Management of Acute Coronary Syndrome Without ST-Segment Elevation: Clinical Profiles and Therapeutic Approaches

Abstract

Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Cheikh Zaid Foundation Ethics Committee issued approval CEFCZ/TFE/7MD_23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.; Objective Acute coronary syndrome without ST-segment elevation, which includes Non-ST-segment elevation myocardial infarction (NSTEMI), represents a critical medical emergency due to its high morbidity and mortality rates, its economic impact on public health, and its steadily increasing incidence. This study aims to investigate the epidemiological, clinical, paraclinical, and therapeutic profiles of NSTEMI patients at Cheikh Zaid International University Hospital. Methods This retrospective, single-center study was conducted over a period of three years, from January 2020 to December 2022, at Cheikh Zaid International University Hospital. It included 140 patients who were admitted directly to the cardiology department or through the emergency department for NSTEMI, provided their medical records were complete and usable for clinical, paraclinical, therapeutic, and evolutionary data. NSTEMI was diagnosed based on a combination of clinical criteria, including chest pain, electrocardiogram (ECG) findings such as ST-segment depression or T-wave inversions, and elevated troponin levels above the established threshold (≥35 pg/mL). Results The mean age of the study population was 66±9.64 years. Males constituted 77% (n=108) of the cohort. The most common cardiovascular risk factors were hypertension (53.6%, n=75), diabetes (50.7%, n=71), and smoking (34.3%, n=48). Biochemical markers showed elevated troponin levels (>35 pg/mL in 72.66%, n=101) and LDL-C levels >0.55 g/L (n=92, 65.7%). Echocardiography revealed hypokinesia in 49.3% (n=69) and moderate to severe left ventricular dysfunction (LVEF <50%) in 37.86% (n=53). Coronary angiography showed single-vessel disease in 43.6% (n=61), with the anterior interventricular artery affected in 44% (n=62). Regarding treatment, 58.5% (n=82) underwent percutaneous coronary intervention (PCI), 27% (n=37) underwent coronary artery bypass grafting (CABG), and 15% (n=21) were managed with medical therapy alone. The in-hospital mortality rate was 3% (n=4). Beyond mortality, complications such as heart failure and recurrent ischemia were observed in a subset of patients, further emphasizing the need for timely intervention. Conclusions Delayed admission is associated with worsened patient outcomes by limiting the efficacy of reperfusion strategies. High-risk patients require urgent management in line with international guidelines. To improve survival and long-term prognosis, increasing public awareness, particularly about early symptom recognition, and improving pre-hospital triage infrastructure are essential. Further, enhancing the public's understanding of cardiovascular risk factors and the importance of early medical consultation could significantly impact the reduction of delays in care. (Copyright © 2025, Touiti et al.)