MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado) study. General findings.
OBJECTIVE
To investigate the clinical characteristics and treatment of acute coronary syndromes (ACS), and to determine the effects of an early invasive strategy (EIS) in non-ST-elevation ACS (NSTEACS) and of primary percutaneous coronary intervention (PCI) in ST-elevation ACS (STEACS).


METHODS
Data were collected prospectively for 9 months during 2004-2005 from 50 hospitals, which were randomly selected according to the level of care provided. In addition, follow-up data on mortality and readmission for ACS were collected for 6 months. The adjusted effects of different reperfusion strategies were analyzed.


RESULTS
After checking data quality, the analysis included data from 32 hospitals, which covered 7923 coronary events (4431 [56%] STEACS, 3034 [38%] NSTEACS and 458 [6%] unclassified ACS) in 7251 patients. Compared with previous studies, the use of primary PCI in STEACS had increased markedly (from 10.7% to 36.8% of patients undergoing reperfusion), as had the use of EIS in NSTEACS (from 11.1% to 19.6%). Overall in-hospital mortality was 5.7% (95% confidence interval [CI], 5.1%-6.2%); for STEACS it was 7.6% (95% CI, 6.7%-8.7%), for NSTEACS 3.9% (95% CI, 3.3%-4.6%), and for unclassified ACS 8.8% (95% CI, 6.2%-12.2%). In the population as a whole, there was no association between prognosis (i.e., 6-month mortality) and EIS in NSTEACS (hazard ratio [HR]=0.94; 95% CI, 0.66-1.3) or between prognosis and primary PCI in STEACS (HR=1; 95% CI, 0.7-1.5). Findings for mortality and rehospitalization for ACS at 6 months were similar.


CONCLUSIONS
Data for 2004-2005 demonstrated a marked increase in the use of invasive procedures. However, the procedures employed were poorly matched to the patients' baseline risk.
Ferreira-González
Ignacio
I
Unidad de Epidemiología, Servicio de Cardiología, Hospital Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Permanyer-Miralda
Gaietà
G
Marrugat
Jaume
J
Heras
Magda
M
Cuñat
José
J
Civeira
Emilia
E
Arós
Fernando
F
Rodríguez
Juan J
JJ
Sánchez
Pedro L
PL
Bueno
Héctor
H
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D012042:Registries; D013030:Spain