Original article
Prognosis and Management of Acute Coronary Syndrome in Spain in 2012: The DIOCLES StudyPronóstico y manejo del síndrome coronario agudo en España en 2012: estudio DIOCLES

https://doi.org/10.1016/j.rec.2014.03.010Get rights and content

Abstract

Introduction and objectives

To identify the current mortality and management of patients admitted for suspected acute coronary syndrome in Spain. The last available registry (2004-2005) reported an in-hospital mortality of 5.7%.

Methods

The study included patients consecutively admitted between January and June 2012 at 44 hospitals selected at random. Information was collected on clinical course at admission and on events at 6 months.

Results

A total of 2557 patients admitted with suspected acute coronary syndrome were included: 788 (30.8%) with ST-segment elevation, 1602 (62.7%) without ST-segment elevation, and 167 (6.5%) with unclassified acute coronary syndrome. In-hospital mortality was 4.1% (6.6%, 2.4%, and 7.8% respectively), significantly lower than that observed for 2004-2005. Reperfusion treatment (most commonly, primary percutaneous coronary intervention) was administered to 85.7% of patients with ST-segment elevation attended within 12 h. The median time from first medical contact to thrombolysis was 40 min and to balloon inflation, 120 min. Among patients without ST-segment elevation, coronary angiography was performed in 80.6%, percutaneous intervention in 52.0%, and surgery was indicated in 6.4%. Secondary prevention treatments at discharge was prescribed more often than in earlier registries. In patients alive at discharge (follow-up available for 97.1%), 6-month mortality was 3.8%.

Conclusions

Mortality among patients with acute coronary syndrome in Spain was lower than that reported in the most recent published studies, in parallel with a more frequent use of the main treatments recommended.

Resumen

Introducción y objetivos

Conocer la mortalidad y el manejo actuales de los pacientes ingresados por sospecha de síndrome coronario agudo en España. El último registro disponible (2004-2005) reportó una mortalidad hospitalaria del 5,7%.

Métodos

Se incluyó a los pacientes ingresados consecutivamente de enero a junio de 2012 en 44 hospitales seleccionados al azar. Se recogió la evolución en el ingreso y los eventos a 6 meses.

Resultados

Se incluyó a 2.557 pacientes ingresados con sospecha de síndrome coronario agudo: 788 (30,8%) con elevación del segmento ST, 1.602 (62,7%) sin elevación del segmento ST y 167 (6,5%) con síndrome coronario agudo inclasificable. La mortalidad hospitalaria fue del 4,1% (el 6,6, el 2,4 y el 7,8% respectivamente), significativamente menor que la registrada en 2004-2005. Se realizó tratamiento de reperfusión (más frecuentemente intervención coronaria percutánea primaria) en el 85,7% de los pacientes con elevación del segmento ST atendidos en < 12 h. La mediana del tiempo desde el primer contacto médico hasta la trombolisis fue 40 min y hasta el inflado del balón, 120 min. Al 80,6% de los pacientes sin elevación del segmento ST, se les realizó coronariografía; al 52,0%, intervención percutánea, y al 6,4%, se le indicó cirugía. La prescripción de tratamientos de prevención secundaria al alta aumentó respecto a registros previos. La mortalidad a 6 meses entre los pacientes dados de alta con vida (seguimiento disponible en el 97,1%) fue del 3,8%.

Conclusiones

La mortalidad de los pacientes con síndrome coronario agudo en España ha disminuido respecto a los últimos datos disponibles, en paralelo a un uso más frecuente de los principales tratamientos recomendados.

Section snippets

INTRODUCTION

Acute coronary syndrome (ACS) is the main complication of ischemic heart disease and has considerable health impact.1, 2 In Spain, several ACS registries3, 4, 5, 6, 7 have investigated the prognosis and management of the condition and its clinical course over time.8

The MASCARA study7 included patients from 2004 to 2005 and is the last of these large registries. Since then, ACS management has seen several changes, such as the widespread use of reperfusion therapies for ST-segment elevation ACS

Study Design

This multicenter, observational, cross-sectional study prospectively collected admission data and performed 6-month follow-up among patients ≥ 18 subsequently admitted for suspected ACS that was first managed at the participating site (except prehospital treatment or admission a few hours after primary PCI at another site) and who gave written consent. Consent was not required to analyze cases of in-hospital death. Patients were excluded if ACS was secondary to other processes, such as

Baseline Characteristics and Clinical Presentation

The study included 44 sites in 13 autonomous communities (all except for Balearic Islands, Canary Islands, Castile-LaMancha, and La Rioja, which are not represented because no hospitals in these communities were selected at random or due to administrative delays). A total of 3059 patients were assessed, and 502 of these were excluded for the reasons described in Figure 1. Therefore, the study included 2557 patients: 788 (30.8%) with an admission diagnosis of STEACS, 1602 (62.7%) with NSTEACS,

DISCUSSION

In this registry, the in-hospital mortality of patients admitted to Spanish hospitals for suspected ACS was 4.1%, a significantly lower figure than that reported in the last registry available.7 Additionally, an increase was observed in the use of recommended treatments, such as reperfusion in STEACS, coronary angiography and revascularization in NSTEACS, and secondary-prevention therapies at discharge.

CONCLUSIONS

The mortality of patients with ACS in Spain has dropped compared with the mortality reported by the last available registry, in keeping with a more frequent use of recommended treatments, such as reperfusion, revascularization, and secondary prevention measures. Several aspects, particularly time to reperfusion in STEACS, are less than optimal.

FUNDING

This study was funded by an unrestricted grant from Daiichi-Sankyo-Lilly.

CONFLICT OF INTERESTS

None declared.

ACKNOWLEDGMENTS

The authors acknowledge assistance from the Daiichi Sankyo/Lilly alliance to conduct this study.

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1

The Appendix contains a list of the participating investigators.

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