title: Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit.
abstract: OBJECTIVE
  Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome.
  
  
  METHODS
  A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol.
  
  
  RESULTS
  The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications.
  
  
  CONCLUSIONS
  After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain. Electronic address: acorderofort@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: López-Palop
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Frutos
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Miralles
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Gunturiz
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: María
authors.initials: M
authors.lastname: García-Carrilero
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003325:Coronary Care Units; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Código infarto; Infarction code; Mortalidad; Mortality; Revascularización; Revascularization; Síndrome coronario agudo