Gap between guidelines and management of patients with acute coronary syndrome without persistent ST elevation. Finnish prospective follow-up survey.
OBJECTIVE
To evaluate how new treatment guidelines of acute coronary syndrome (ACS) without ST elevation have been implemented into clinical practice in Finland.


METHODS
A prospective survey on 501 consecutive patients (mean age 68 [range 27-96] years) admitted to nine hospitals in Finland with suspected ACS without persistent ST elevation between January and March 2001.


RESULTS
The rate of death was 4.2% in hospital and 9.8% at 6 months. Six-month composite incidence of death, new myocardial infarction, refractory angina or readmission for unstable angina was 25.4%. The majority of patients had beta-blocker and aspirin both in hospital and at 6 months. Low molecular weight heparin was used in 76% of patients. Statins were used in 52% of patients in hospital and in 64% at 6 months. Glycoprotein (GP) IIb/IIIa receptor antagonists were used in 18% of all patients. The overall rate of coronary angiography was 40% in hospital and 54% at 6 months, but there was large interhospital variation. Overall, only 45% of very high-risk patients underwent angiography during initial hospitalization. Very high-risk patients had longer waiting times for angiography than low-risk patients (5.8 vs 4.5 days, p < 0.05).


CONCLUSIONS
Traditional medication with aspirin and beta-blocker is widely used in ACS, whereas statins, GPIIb/IIIa receptor antagonists and invasive therapy are underused. Well-known risk factors were poor predictors of receiving in-hospital angiography. Implementation of new ESC guidelines into clinical practice needs further education and more resources.
Vikman
Saila
S
Department of Medicine, University Hospital of Tampere, University of Tampere, Finland. saila.vikman@pshp.fi
Airaksinen
K E Juhani
KE
Peuhkurinen
Keijo
K
Tierala
Ilkka
I
Majamaa-Voltti
Kirsi
K
Niemelä
Matti
M
Niemelä
Kari
K
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003625:Data Collection; D019468:Disease Management; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010343:Patient Admission; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014336:Troponin