title: Polish Registry of Acute Coronary Syndromes (PL-ACS). Characteristics, treatments and outcomes of patients with acute coronary syndromes in Poland.
abstract: BACKGROUND
  In Poland, together with the transformation of the political system, significant positive changes have been made to the national health care system. This provided a possibility for hospitals to apply current standards of care to patients with acute coronary syndromes (ACS).
  
  
  OBJECTIVE
  To assess contemporary data on epidemiology, management and outcomes of patients with ACS in Poland, and to evaluate adherence to the guidelines' recommended treatment.
  
  
  METHODS
  We performed an observational study of 100,193 patients hospitalised due to unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI), prospectively enrolled in 417 hospitals from October 2003 to March 2006 in the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS). The registry is carried out in cooperation with the Ministry of Health and the National Health Fund.
  
  
  RESULTS
  The initial diagnoses were unstable angina in 42.2%, NSTEMI in 26.6%, and STEMI in 31.2% of patients. About one-third of patients were treated outside of cardiology departments (mainly in the internal medicine wards). In patients without ST elevation, invasive strategy (early coronary angiography) was used with almost equal frequency in unstable angina (29.4%) and NSTEMI (31.7%). However, in-hospital mortality was low in unstable angina (0.8%), being much higher in NSTEMI patients (6.6%), (p<0.001). In STEMI reperfusion therapy was administered in 63.3% of patients (thrombolysis 7.8%, primary PCI 54.1%, and PCI after thrombolysis 1.4%). In-hospital mortality in STEMI was 9.3%. Median times from the onset of symptoms to invasive treatment were: 37 hours in unstable angina, 23 hours in NSTEMI, and 5 hours in STEMI. The guidelines' recommended pharmacotherapy was used in a high percentage of patients except for thienopyridines and GP IIb/IIIa inhibitors.
  
  
  CONCLUSIONS
  The Polish Registry of Acute Coronary Syndromes shows several discrepancies between guidelines' recommended treatment and their utilisation in everyday practice. Particularly, the under-utilisation of invasive treatment in patients with NSTEMI is alarming. Efforts should be made to increase the usage of invasive treatment in NSTEMI patients and to shorten the delay from the symptom onset to intervention.
authors.affiliation: Silesian Centre for Heart Diseases, Zabrze, Poland. scchs@sum.edu.pl
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gasior
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Andrzej
authors.initials: A
authors.lastname: Cieśliński
authors.forename: Jacek S
authors.initials: JS
authors.lastname: Dubiel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gil
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyłło
authors.forename: Maria
authors.initials: M
authors.lastname: Trusz-Gluza
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006329:Heart Conduction System; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011044:Poland / Q000453:epidemiology; D012042:Registries; D015912:Thrombolytic Therapy