Determinants of use and outcomes of invasive coronary procedures in acute coronary syndromes: results from ENACT.
OBJECTIVE
To explore the variations in the use of invasive coronary procedures after acute coronary syndromes.


RESULTS
In the ENACT registry, use of invasive procedures was analyzed as a function of hospital type, country and patient characteristics among 2768 patients with acute coronary syndromes (731 with ST-segment elevation myocardial infarction (STEMI) within 12h of symptom onset, and 2037 with other acute coronary syndromes). Percutaneous coronary intervention (PCI) was more likely to be performed in teaching than in community hospitals, and in hospitals with, rather than without, catheterization facilities. There were marked country-to-country variations in the use of PCI during the index hospital stay, ranging from 8 to 67% after STEMI (p<0.001) and from 9 to 44% after other acute coronary syndromes (p<0.001). The main independent predictors of the performance of PCI were the country rate of use of PCI and the hospital availability of PCI. For patients with other acute coronary syndromes, the risk of adverse events, assessed by the simplified TIMI-risk score, was not associated with PCI. Logistic regression analysis showed that lack of PCI was an independent predictor of in-hospital mortality (odds ratio (OR): 3.75, p<0.029) after other acute coronary syndromes, but not after STEMI.


CONCLUSIONS
The use of PCI after acute coronary syndromes appears related more to local practice and hospital characteristics than to patients' characteristics or risk.
Gabriel Steg
Philippe
P
Hôpital Bichat, 46 rue Henri Huchard, 75877 Cedex 18, Paris, France. gabriel.steg@bch.ap-hop-paris.fr
Iung
Bernard
B
Feldman
Laurent J
LJ
Maggioni
Aldo P
AP
Keil
Ulrich
U
Deckers
Jaap
J
Cokkinos
Dennis
D
Fox
Keith A A
KA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004638:Emergency Treatment; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis