Adherence to guidelines in the treatment of acute coronary syndromes: progress over time.
BACKGROUND
Treatment of acute coronary syndromes (ACS) has changed considerably in the last few years, as reflected in various proposals for guidelines by the ACC/AHA/ESC based on clinical evidence. We analyzed the clinical implementation of these recommendations in our patient population between 2002 and 2005.


METHODS
This was a retrospective study of 368 patients admitted in 2002 and 420 patients admitted in 2005 for ACS (with and without ST-segment elevation). We analyzed clinical characteristics and treatment strategies.


RESULTS
There were no differences in terms of age, gender ratio, risk factors for coronary artery disease, or previous myocardial revascularization. There was a decrease in the number of patients with previous myocardial infarction and renal insufficiency on admission, and an increase in patients with ST-segment elevation on admission. Treatment with clopidogrel (6% vs. 87%), beta-blockers (54% vs. 79%), angiotensin-converting enzyme inhibitors (72% vs. 84%) and statins (78% vs. 91%) increased (all with p < 0.001). On the other hand, there was a slight decrease in the use of aspirin (98% vs. 95%, p = 0.039) (with greater use of clopidogrel) and ticlopidine was no longer used (46% vs. 0%, p < 0.001). Use of glycoprotein IIb/IIIa receptor antagonists did not change significantly (66% vs. 67%, p = NS). Percutaneous coronary interventions increased (53% vs. 67% p < 0.001). There was no difference in in-hospital mortality (8.2% vs. 6.4%) or 30-day mortality (9.0% vs. 8.6%), but mortality was lower at one-year follow-up (17.1% vs. 11.7%, p = 0.039). Statins and beta-blockers are independent predictors of mortality during follow-up, with a protective effect.


CONCLUSIONS
Between 2002 and 2005, treatment of ACS improved significantly according to existing guidelines, leading to improvement in medium-term mortality.
Timóteo
Ana Teresa
AT
Serviço Cardiologia, Hospital Santa Marta, Lisboa, Portugal. ana_timoteo@yahoo.com
Fiarresga
António
A
Feliciano
Joana
J
Ferreira
Maria Lurdes
ML
Oliveira
José Alberto
JA
Serra
José
J
Ferreira
Rui
R