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Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry
  1. M Heras1,
  2. H Bueno2,
  3. A Bardají3,
  4. A Fernández-Ortiz4,
  5. H Martí5,
  6. J Marrugat5,
  7. on behalf of the DESCARTES Investigators
  1. 1Department of Cardiology of Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
  2. 2Department of Cardiology of Hospital Gregorio Marañón, Madrid, Spain
  3. 3Department of Cardiology of Hospital Joan XXIII, Tarragon, Spain
  4. 4Department of Cardiology of Hospital Clínico, Madrid, Spain
  5. 5Institut Municipal d’Investigació Mèdica and Universitat Autònoma de Barcelona, Barcelona, Spain
  1. Correspondence to:
    Dr Magda Heras
    ICMCV Department of Cardiology, Villarroel, 170, 08036 Barcelona, Spain; mheras{at}clinic.ub.es

Abstract

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, β 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.

  • 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

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Footnotes

  • Published Online First 27 April 2006

  • Funds for the registry were generously donated by BMS (Bristol Myers Squibb) with an unrestricted grant.

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