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[Coverage of pointed acute coronary syndromes in the general hospital centers]
M Hanssen1, J P Monassier, J J Dujardin
1Service de cardiologie interventionnelle, centre hospitalier, 64, avenue du Pr. Leriche, 67504 Haguenau, France. michel.hanssen@ch-haguenau.fr
Insights
This French registry study analyzed 607 acute coronary syndrome patients, finding good guideline adherence for non-ST elevation but suboptimal reperfusion for ST-elevation cases. Age and lack of angiography predicted higher in-hospital mortality.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Context:
- National registry data from 86 French institutions in September 2000.
- 607 patients with acute coronary syndromes (ACS) analyzed (mean age 67, 413 men).
- Diagnoses included unstable angina (38%), non-Q wave myocardial infarction (21%), and Q-wave myocardial infarction (40.5%).
Purpose:
- To evaluate the management and in-hospital outcomes of acute coronary syndromes in France.
- To assess adherence to European Society of Cardiology guidelines.
- To identify predictors of in-hospital mortality in ACS patients.
Summary:
- Median time to admission was 4 hours; 46% contacted general practitioners first.
- Guideline adherence was good for non-ST elevation ACS.
- For ST-elevation ACS, 57% received reperfusion therapy (pre-hospital thrombolysis 9%, hospital thrombolysis 28%, angioplasty 27%).
Impact:
- In-hospital mortality was 6% overall and 11% for acute myocardial infarctions.
- Multivariate analysis identified age, ACS type, absence of beta-blocker therapy, and absence of coronary angiography as mortality predictors.
- Findings highlight areas for improvement in ACS management, particularly for ST-elevation myocardial infarction.
Abstract:
This study presents data on the management of acute coronary syndromes collected in a national registry organized by the french Collège national des cardiologues des hôpitaux généraux in September 2000. In all 86 institutions participated and data from 607 patients (mean age: 67 years; 413 men) were analysed. The final diagnosis was unstable angina in 38%, non-Q wave myocardial infarction in 21% and Q-wave myocardial infarction in 40.5%. Median time to admission was 4 h. At symptom onset, patients called their general practitioners in 46% of cases, emergency ambulatory units in 31% of cases and arrived to the hospital on their own in 23% of cases. Observance of the European Society of Cardiology guidelines was good for patients without ST segment elevation. In patients with ST segment elevation, 9% had pre-hospital thrombolysis, 28% hospital thrombolysis, and 27% had angioplasty within 48 h of admission, including 9% with rescue angioplasty. Overall, 57% of patients with ST segment elevation received reperfusion therapy. In hospital mortality was 6% for the whole cohort, and 11% for patients with acute myocardial infarctions. By multivariate analysis, predictors of in-hospital mortality were age, type of acute coronary syndrome, absence of beta-blocker therapy, and absence of coronary angiography.