[Treatment of the acute coronary syndrome in Germany: experiences in a German cluster of the GRACE registry].
BACKGROUND
The acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the western world. The Global Registry of Acute Coronary Events (GRACE) documents inpatients with all types of ACS and a follow-up at three months in Germany and worldwide.


METHODS
The data of the German Cluster Detmold were compared with data from the worldwide GRACE registry (31,070 patients). Data from 849 patients with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) were collected from October 2001 to September 2005 in eight participating hospitals in the GRACE2 Cluster Detmold.


RESULTS
Compared with the worldwide GRACE data the patients in the Cluster Detmold had longer pre-hospital admission times (STEMI patients < 1 h: 13.9 % vs. 17.0 %; p < 0.05); more frequent interventions (PCI 60.1 % vs. 48.7%; p < 0.001) and less thrombolysis (17.9 vs. 42.5%; p < 0.001) in STEMI patients; more frequent use of platelet inhibitors (clopidogrel and ticlopidine, 93.4 % vs. 89.4%; p < 0.001) and unfractionated heparin (69.8 % vs. 36.5; p < 0.001), and less frequent use of low molecular weight heparin (31.1 % vs. 51.2%; p < 0.001); more frequent use of RAS blocking agents (80.2 vs. 66.6, p < 0.001) and beta blockers (87.4 vs. 78.8, p < 0.001) and less frequent use of lipid lowering agents (23.5 vs. 72.5%; p < 0.001).


CONCLUSIONS
Current management of ACS in Germany closely follows the recommendations of the German society of Cardiology. Differences in practice may account for the observed substantially lower event rates in Germany during hospitalization, but there is still room for improvement in the pre-hospital phase und in the degree to which pharmacotherapy is used for secondary prevention.
Tebbe
U
U
Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, Detmold. ulrich.tebbe@klinikum-lippe.de
Bramlage
P
P
von Löwis of Menar
P
P
Lawall
H
H
Gaudron
P
P
Lüders
S
S
Klaus
A
A
Lengfelder
W
W
Scholz
K H
KH
Maziejewski
S
S
Cuneo
A
A
Hohmann
V
V
Gulba
D
D
D000208:Acute Disease; D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012042:Registries; D015912:Thrombolytic Therapy
D018674:Adrenergic Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000924:Anticholesteremic Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors