CARDIOVASCULAR MEDICINE

¹ Department of Cardiology of Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
² Department of Cardiology of Hospital Gregorio Marañón, Madrid, Spain
³ Department of Cardiology of Hospital Joan XXIII, Tarragon, Spain
⁴ Department of Cardiology of Hospital Clínico, Madrid, Spain
⁵ Institut Municipal d’Investigació Mèdica and Universitat Autònoma de Barcelona, Barcelona, Spain

Correspondence to:
Dr Magda Heras
ICMCV Department of Cardiology, Villarroel, 170, 08036 Barcelona, Spain; mheras{at}clinic.ub.es

Objective: To analyse intensity of treatment of high-risk patients with non-ST elevation acute coronary syndromes (NSTEACS) included in the DESCARTES (Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español) registry.

Patients and setting: Patients with NSTEACS (n = 1877) admitted to 45 randomly selected Spanish hospitals in April and May 2002 were studied.

Design: Patients with ST segment depression and troponin rise were considered high risk (n = 478) and were compared with non-high risk patients (n = 1399).

Results: 46.9% of high-risk patients versus 39.5% of non-high-risk patients underwent angiography (p = 0.005), 23.2% versus 18.8% (p = 0.038) underwent percutaneous revascularisation, and 24.9% versus 7.4% (p < 0.001) were given glycoprotein IIb/IIIa inhibitor. In-hospital and six-month mortality were 7.5% versus 1.1% and 17% versus 4.6% (p < 0.001), respectively. A treatment score ( 4, 2–3 and < 2) was defined according to the number of class I interventions recommended in clinical guidelines: aspirin, clopidogrel, ß blockers, angiotensin-converting enzyme inhibitors, statins and revascularisation. Independent predictors of six-month mortality were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04 to 1.10, p < 0.001), diabetes (OR 1.92, 95% CI 1.14 to 3.22, p = 0.014), previous cardiovascular disease (OR 4.17, 95% CI 1.63 to 10.68, p = 0.003), high risk (OR 2.20, 95% CI 1.30 to 3.71, p = 0.003) and treatment score < 2 versus 4 (OR 2.87, 95% CI 1.27 to 6.52, p = 0.012).

Conclusions: Class I recommended treatments were underused in high-risk patients in the DESCARTES registry. This undertreatment was an independent predictor of death of patients with an acute coronary syndrome.

Abbreviations: ACE, angiotensin-converting enzyme; CRUSADE, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines; DESCARTES, Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español; FRISC II, FRagmin and Fast Revascularisation during InStability in Coronary artery disease; GRACE, Global Registry of Acute Coronary Events; NSTEACS, non-ST elevation acute coronary syndromes; PCI, percutaneous coronary intervention; PEPA, Proyecto de Estudio del Pronostico de la Angina

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Halim, S. A., Mulgund, J., Chen, A. Y., Roe, M. T., Peterson, E. D., Gibler, W. B., Ohman, E. M., Newby, L. K. (2009). Use of Guidelines-Recommended Management and Outcomes Among Women and Men With Low-Level Troponin Elevation: Insights From CRUSADE. Circ Cardiovasc Qual Outcomes 2: 199-206 [Abstract] [Full Text]