PT  - JOURNAL ARTICLE
AU  - M Heras
AU  - H Bueno
AU  - A Bardají
AU  - A Fernández-Ortiz
AU  - H Martí
AU  - J Marrugat
TI  - Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry
AID  - 10.1136/hrt.2005.079673
DP  - 2006 Nov 01
TA  - Heart
PG  - 1571--1576
VI  - 92
IP  - 11
4099  - http://heart.bmj.com/content/92/11/1571.short
4100  - http://heart.bmj.com/content/92/11/1571.full
SO  - Heart2006 Nov 01; 92
AB  - 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.