title: Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III).
abstract: OBJECTIVE
  To describe current management and clinical outcomes in patients hospitalized with an acute coronary syndrome (ACS) in Mexico.
  
  
  METHODS
  RENASICA III was a prospective multicenter registry of consecutive patients hospitalized with an ACS. Patients had objective evidence of ischemic heart disease; those with type II infarction or secondary ischemic were excluded. Study design conformed to current quality recommendations.
  
  
  RESULTS
  A total of 123 investigators at 29 tertiary and 44 community hospitals enrolled 8296 patients with an ACS (4038 with non-ST-elevation myocardial infarction/unstable angina [NSTEMI/UA], 4258 with ST-elevation myocardial infarction [STEMI]). The majority were younger (62±12years) and 76.0% were male. On admission 80.5% had ischemic chest pain lasting >20min and clinical stability. Left ventricular dysfunction was more frequent in NSTEMI/UA than in those with STEMI (30.0% vs. 10.7%, p<0.0001). In STEMI 37.6% received thrombolysis and 15.0% primary PCI. PCI was performed in 39.6% of NSTEMI/UA (early strategy in 10.8%, urgent strategy in 3.0%). Overall hospital death rate was 6.4% (8.7% in STEMI vs. 3.9% in NSTEMI/UA, p<0.001). The strongest independent predictors of hospital mortality were cardiogenic shock (odds ratio 22.4, 95% confidence interval 18.3-27.3) and ventricular fibrillation (odds ratio 12.5, 95% confidence interval 9.3-16.7).
  
  
  CONCLUSIONS
  The results from RENASICA III establish the urgent need to develop large-scale regional programs to improve adherence to guideline recommendations in ACS, including rates of pharmacological thrombolysis and increasing the ratio of PCI to thrombolysis.
authors.affiliation: Executive Committee of RENASICA III, Mexico; Emergency Department and Coronary Critical Care, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez-Sanchez
authors.affiliation: Executive Committee of RENASICA III, Mexico; Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Borrayo
authors.affiliation: Executive Committee of RENASICA III, Mexico; Cardiology Department in Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Carrillo
authors.affiliation: Executive Committee of RENASICA III, Mexico; Instituto Nacional de Cardiologia Ignacio Chavez, Mexico.
authors.forename: Ursulo
authors.initials: U
authors.lastname: Juarez
authors.affiliation: Executive Committee of RENASICA III, Mexico; Hemodynamic Laboratory, Hospital San Jose and Instituto de Cardiologia y Medicina Vascular, TEC Salud, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Quintanilla
authors.affiliation: Executive Committee of RENASICA III, Mexico; National Coordinator, Mexico; Instituto de Cardiologia y Medicina Vascular, TEC Salud, Mexico; Translational Research Center, Escuela de Medicina, Tecnologico de Monterrey, Mexico. Electronic address: jerjes@prodigy.net.mx.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jerjes-Sanchez
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
keywords: Acute coronary syndromes; Angina inestable; Infarto del miocardio con elevación del ST; Infarto del miocardio sin elevación del ST; Mexico; México; Non-ST elevation myocardial infarction; ST-elevation myocardial infarction; Síndromes coronarios agudos; Unstable angina