title: Management of acute coronary syndromes in Maghreb countries: The ACCESS (ACute Coronary Events - a multinational Survey of current management Strategies) registry.
abstract: BACKGROUND
  The burden of cardiovascular diseases is anticipated to rise in developing countries. We sought to describe the epidemiology, management, and clinical outcomes of patients hospitalized with acute coronary syndromes (ACS) in three countries in western North Africa.
  
  
  METHODS
  Adult patients hospitalized with a diagnosis of ACS were enrolled in the prospective ACute Coronary Events - a multinational Survey of current management Strategies (ACCESS) registry over a 13-month period (January 2007 to January 2008). We report on patients enrolled at sites in Algeria, Morocco and Tunisia. A standardized form was used to collect data on patient characteristics, treatments and outcomes.
  
  
  RESULTS
  A total of 1687 patients with confirmed ACS were enrolled (median age 59 [interquartile range 52, 68] years; 76% men), 59% with ST-elevation myocardial infarction (STEMI) and 41% with non-ST-elevation ACS (NSTE-ACS). During hospitalization, most patients received aspirin (96%) and a statin (90%), 83% received a beta-blocker and 74% an angiotensin-converting enzyme inhibitor. Among eligible STEMI patients, 42% (419/989) did not receive fibrinolysis or undergo percutaneous coronary intervention. All-cause death at 12 months was 8.1% and did not differ significantly between patients with STEMI or NSTE-ACS (8.3% vs 7.7%, respectively; Log-rank test P=0.82). Clinical factors associated with higher risk of death at 12 months included cardiac arrest, cardiogenic shock, bleeding episodes and diabetes, while percutaneous coronary intervention and male sex were associated with lower risk.
  
  
  CONCLUSIONS
  In this observational study of ACS patients from three Maghreb countries, the use of evidence-based pharmacological therapies for ACS was quite high; however, 42% of the patients with STEMI were not given any form of reperfusion therapy.
authors.affiliation: Service des soins intensifs et rythmologie, faculté de médecine de Rabat, hôpital militaire d'instruction Mohammed V, Rabat, Morocco. moustaghfir64@gmail.com
authors.forename: Abdelhamid
authors.initials: A
authors.lastname: Moustaghfir
authors.forename: Mohand
authors.initials: M
authors.lastname: Haddak
authors.forename: Rachid
authors.initials: R
authors.lastname: Mechmeche
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000462:Algeria / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D019468:Disease Management; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents