[Feasibility of implementation of guidelines for the management of acute coronary syndrome in cardiac unit of a community hospital].
OBJECTIVE
To assess feasibility of implementation of Guidelines of Russian Society of Cardiology (RSC) on the management of non ST elevation acute coronary syndrome (adaptation of Guidelines of the European Society of Cardiology) in an ordinary noninvasive community hospital.


METHODS
Retrospective analysis of inhospital management of 266 consecutive patients with acute coronary syndromes without persistent ST elevation admitted to coronary unit of a community hospital in January-July, 2001.


RESULTS
Main characteristics of the group: mean age 69 years (34% >75 years), men - 56%, history of myocardial infarction - 38%, hypertension - 67%, diabetes - 23%, pain at rest as an index event - 98%, symptoms duration exceeding 20 min - 61%, ECG changes - 87% (42% ST deviation), signs of left ventricular failure - 14%. Myocardial infarction as index event was diagnosed in 32% of pts by serial measurement of total CK activity. There were no angiographies or revascularizations during hospital stay (20-/+6 days) because of absence of catheterization facilities. Medical treatment: antiplatelet agents - 99% (98% - aspirin) of patients; proportion of patients treated with heparins - 83% (low molecular weight heparins - 18,5%). Most of the patients received b-blockers (79%) and nitrates (78%). Use of calcium channel blockers was relatively low (15%). Few patients (20%) received statins. Inhospital rate of death and nonfatal myocardial infarction was 3,5% i 3%, respectively. Rate of chest pain recurrence was high (38% overall, 26% with ischemic ST-T ECG changes) and at least partially could be explained by the lack of invasive interventions.


CONCLUSIONS
Management of patients with non ST elevation ACS in coronary unit of a community hospital during the period surveyed in this study was in line with corresponding RSC guidelines (as related to noninvasive treatment) except duration of hospitalization. This was associated with acceptable rate of death or/and myocardial infarction (6,5%) in a group of relatively high risk pts. High rate of angina recurrences during rather long hospital stay reflected absence of invasive treatment.
Averkov
O V
OV
Lysov
A Yu
AY
Erlikh
A D
AD
Gratsianskiĭ
N A
NA
D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D003327:Coronary Disease / Q000534:rehabilitation*; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017408:Guidelines as Topic; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D008074:Lipoproteins; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D008074:Lipoproteins; C051928:lipoprotein-associated coagulation inhibitor; D013300:Streptokinase