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Comparison of Pretreatment in European Society of Cardiology Acute Coronary Syndrome Guidelines
İsmail Ataş1, Mümin Murat Yazıcı1, Ahmet Nurhak Çakır2
1Recep Tayyip Erdoğan University Training and Research Hospital, Department of Emergency Medicine, Rize, Türkiye.
Insights
Pretreatment compliance with acute coronary syndrome (ACS) guidelines was low overall. New European Society of Cardiology guidelines showed lower pretreatment compliance than previous ones, particularly for P2Y12 inhibitors in ST-elevation myocardial infarction.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Acute coronary syndrome (ACS) is a leading cause of pre-hospitalization death.
- Early diagnosis and intervention are critical for managing ACS.
- This study evaluates ACS pretreatment guideline adherence.
Purpose of the Study:
- To assess the appropriateness of ACS pretreatment based on 2017, 2020, and 2023 European Society of Cardiology guidelines.
- To compare pretreatment compliance rates between previous and new ACS guidelines.
Main Methods:
- Retrospective, single-center study of 1,450 patients with prediagnosed ACS referred for percutaneous cardiac intervention (PCI).
- Patients were divided into two groups based on guideline publication date (August 25, 2023): pre-guideline update and post-guideline update.
- Compliance with aspirin, anticoagulants, and P2Y12 inhibitors was analyzed.
Main Results:
- Overall pretreatment compliance with ACS guidelines was low (9.8%).
- Compliance with aspirin and anticoagulants improved under new guidelines, but P2Y12 inhibitor compliance decreased (58.9% vs. 70.0%).
- For ST-elevation myocardial infarction, P2Y12 inhibitor use was less appropriate under new guidelines (31.4% vs. 55.0%).
Conclusions:
- Physician adherence to ACS pretreatment guidelines, both old and new, is low.
- Pretreatment compliance was lower during the period of the new guidelines compared to the previous ones.
- The findings highlight a need for improved guideline implementation in ACS care.
Introduction:
Most patients with acute coronary syndrome (ACS) die before hospitalization. Early diagnosis and effective interventions can prevent the disease from worsening. In this single-center, retrospective study we aimed to investigate the appropriateness of the pretreatment of patients referred to the emergency department of our hospital, a percutaneous cardiac intervention (PCI) center, with a prediagnosis of ACS under the previously published European Society of Cardiology guidelines (2017 and 2020) and the new guidelines published in 2023.
Methods:
Based on the date of publication of the European Society of Cardiology's most recent ACS guidelines (August 25, 2023), we divided patients admitted between August 25, 2022-August 24, 2024, into two groups: patients who were evaluated and received pretreatment under the previous guidelines; and patients who were evaluated and received pretreatment under the new guidelines.
Results:
Of 1,675 patients screened for enrollment who were referred to our PCI center with prediagnosis of ACS, after exclusion criteria, we report on 1,450 (86.6%). Pretreatment (before PCI) compliance rate with all aspects of the previous and new guidelines was low, at 9.8%. Study patients were 69.9% (n = 1,013) male with mean age of 63.9 ± 13.0 years. Comparing the compliance rate between the new versus previous guidelines, for individual components, we found better compliance for aspirin administration (72.6 vs. 66.2%) and anticoagulants (40.3 vs. 22.7%), while for P2Y12 inhibitors, we found lower compliance (58.9 vs. 70.0%, all p< .001). For the subset of patients with ST-elevation myocardial infarction, P2Y12 inhibitors were used less appropriately under the new vs. previous guidelines (31.4 vs. 55.0%, p < .001).
Conclusion:
The compliance rates with the previous and new guidelines for ACS pretreatment by physicians working in hospitals without PCI centers were low. Pretreatment compliance during the new guideline period was lower than compliance during the prior guideline period.
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