[The RECORD registry. Treatment of patients with acute coronary syndromes in hospitals with and without possibilities to perform invasive coronary procedures].
The participants initiated RECORD registry in Russia recruited 796 patients (pts) with ST elevation (STE, n=256) and non ST elevation (NSTE, n=550) acute coronary syndrome (ACS) between 11.2007 and 02.2008. Ten of 18 participating hospitals (H) had facilities for coronary angiography and revascularization (invasive H-IH). STEACS. Percentages of pts with history of heart failure (HF) and with high GRACE score were significantly higher among pts in noninvasive (N) H. Pts in NH also had numerically although insignificantly higher mean age, portions of pts aged 75 years, with history of myocardial infarction (MI), and with Killip class II. In IH 60.9% of pts were subjected to reperfusion therapy (but only 30.4% - to primary PCI). In NH thrombolytic therapy was used in 34.1% of pts. Inhospital mortality was 14.3% in IH and 21.2% in NH. Within IH among pts subjected to PCI (n=49) proportion of persons aged 75 years and mean age were significantly lower compared with nonPCI pts, portion of subjects with high admission GRACE score ( 150) was numerically although insignificantly (p=0.07) smaller. There were no differences in clinical characteristics between nonPCI pts in IH and pts in NH. Therapy of nonPCI pts in IH was closer to guidelines with higher rate of thrombolytic therapy (42 vs 34.1%) and especially of clopidogrel use (42 vs 18.8%). However inhospital mortality of nonPCI pts in IH was closer to that in NH (18.9 vs 21.2%). NSTEACS. Pts in NH had significantly higher age. Portions of pts aged 75 years, with history of MI and of HF, with Killip class II, and high GRACE score in NH were significantly larger than in IH. Treatment of pts in IH was closer to guidelines with significantly higher use of clopidogrel and low molecular weight heparin, 54.3% of pts were subjected to angiography, 24.8% - to PCI, 9.4% - to coronary bypass surgery. Mortality was equal and relatively low in IH and NH (2.8 and 2.7%, respectively) despite differences in clinical characteristics of pts. Within IH invasively compared with noninvasively treated pts had significantly lower mean age and lower portion of pts 75 years, lower portions of pts with history of MI and HF, with Killip class II. Mortality was equal but rate of MI was significantly higher in invasively treated pts. Comparison of results of invasive treatment in IH and treatment in NH: mortality was equally relatively low (2.5 and 2.7%, respectively) despite higher proportions of pts with old age, history of HF, high GRACE score in NH; development of inhospital MI was significantly more frequent among invasively treated pts (7.9 vs 1.7%). Conclusion. Lower risk pts were admitted to IH and within IH lower risk pts were actually subjected to invasive treatment. Results of invasive reperfusion in STEACS were better than results of noninvasive treatment but effect of selection of lower risk pts can not be excluded. No positive effect of either invasive treatment or treatment in advanced H was revealed in NSTEACS.
Érlikh
A D
AD
Gratsianskiĭ
N A
NA
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D000075202:Contraindications; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004562:Electrocardiography; D017052:Hospital Mortality; D006753:Hospital Records; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012042:Registries; D018570:Risk Assessment; D012426:Russia; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality