Use of evidence-based management for acute coronary syndrome

This study compared the management of acute coronary syndrome (ACS) for patients admitted to Dunedin Coronary Care with evidence-based recommendations from the American College of Cardiology / American Heart Association in 1999 and 2002 and with management reported in international and local registries.

All patients with ACS from 2001-2002 were included.

Guidelines stated that aspirin, beta-blockers, statins, and ACE-inhibitors/angiotensin-II-blockers are appropriate treatment for acute coronary syndrome. These medications were prescribed respectively in 98%, 80%, 70% and 55% of patients on discharge. In patients with documented dyslipidaemia, Statins was prescribed in 80% on discharge. The use of ACE inhibitors was 73% in patients with impaired left ventricular function, 79% in patients with clinical heart failure and 84% in patients with anterior ST-elevation myocardial infarction (STEMI). For patients with STEMI, 67% received coronary angiography, 50% had PCI and 7% underwent inpatient coronary artery bypass grafting. For Non-ST-elevation myocardial infarction (NSTEMI), the respective numbers were 73%, 38% and 21%. Our use of evidence-based medications was consistent with published guidelines and comparable to results of international registries (CRUSADE, EUROESPIRE II, GRACE) in 2001-2002.

There is good adherence to the use of evidence-based management for acute coronary syndrome in Dunedin Coronary Care Unit.