title: The use of reperfusion and revascularization procedures in acute coronary syndrome in Portugal: a systematic review.
abstract: OBJECTIVE
  Reperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal.
  
  
  METHODS
  PubMed was searched in July 2012. The proportion of patients treated with fibrinolysis, primary percutaneous coronary intervention (PCI), any PCI and coronary artery bypass grafting (CABG) was described according to type of ACS: STEMI (≥90% patients with ST-segment elevation or Q-wave myocardial infarction), NSTE-ACS (≥90% patients with non-ST-segment elevation ACS) and mixed ACS (all others).
  
  
  RESULTS
  We identified 41 eligible studies, published between 1989 and 2011. Twenty-eight reported on samples considered representative of ACS patients treated in Portugal. The small number of estimates of the use of each treatment in STEMI and NSTE-ACS patients precluded identification of any time trend. In the last 20 years, the proportion of mixed ACS patients treated with fibrinolysis decreased and the use of PCI increased, while the use of CABG did not change.
  
  
  CONCLUSIONS
  The general pattern of the use of reperfusion and revascularization is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients. The relatively small number of estimates on the same procedure in comparable patients limits the generalizability of the conclusions, and highlights the need for systematic approaches to monitor the use of treatments over time.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Lopes-Conceição
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Centro Hospitalar de Trás-Os-Montes e Alto Douro EPE, Vila Real, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Araújo
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Olga
authors.initials: O
authors.lastname: Laszczýnska
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal. Electronic address: anazev@med.up.pt.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D001026:Coronary Artery Bypass; D006801:Humans; D062645:Percutaneous Coronary Intervention; D011174:Portugal
keywords: Acute coronary syndrome; Angioplastia; Angioplasty; Cirurgia de revascularização coronária; Coronary artery bypass; Fibrinolysis; Fibrinólise; Myocardial revascularization; Revascularização miocárdica; Síndrome coronária aguda