title: Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study.
abstract: OBJECTIVE
  Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network.
  
  
  RESULTS
  The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660).
  
  
  CONCLUSIONS
  According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
authors.affiliation: S.M. Misericordia Hospital, Udine, Italy. dichiara.antonio@aoud.sanita.fvg.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Chiara
authors.forename: Claudio
authors.initials: C
authors.lastname: Fresco
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.forename: Cesare
authors.initials: C
authors.lastname: Greco
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.forename: Antonio
authors.initials: A
authors.lastname: Mafrici
authors.forename: Filippo
authors.initials: F
authors.lastname: Ottani
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarella
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors