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  • Title: [Epidemiology of acute coronary syndromes in cardiology departments of the Emilia Romagna region: the AI-CARE2 study].
    Author: Pavesi PC, Ottani F, Bologna F, Gaddi O, Alboni P, Galvani M.
    Journal: Ital Heart J Suppl; 2003 Sep; 4(9):733-44. PubMed ID: 14635391.
    Abstract:
    BACKGROUND: The aim of this study was to better delineate the characteristics, treatments and outcomes of patients with acute coronary syndromes in Emilia Romagna, a region of Italy, with 4 million inhabitants. METHODS: From January 10 to March 12, 2000, we performed a prospective survey (24/27 hospitals of the region) on 1074 consecutive patients with a discharge diagnosis of acute coronary syndrome. RESULTS: Based on the initial electrocardiogram, patients were classified as having an ST-elevation acute coronary syndrome in 41% of cases, a non-ST-elevation acute coronary syndrome in 54%, and an acute coronary syndrome with an undetermined electrocardiographic pattern in 5%. The discharge diagnosis was Q wave myocardial infarction in 43%, non-Q wave myocardial infarction in 26%, and unstable angina in 31% of patients. The use of antiplatelet, beta-blockers, ACE-inhibitors, and antithrombin agents for patients with ST-elevation acute coronary syndromes were 96, 62, 56, and 93%, respectively, with corresponding rates of 93, 63, 53, and 87% for non-ST-elevation acute coronary syndromes. During the initial admission, coronary angiography, percutaneous coronary intervention, and coronary bypass surgery were performed in 31, 15, and 1% of ST-elevation acute coronary syndrome patients, respectively, with corresponding rates of 43, 15, and 5% for non-ST-elevation acute coronary syndromes. Among patients with ST-elevation acute coronary syndromes, 61% received a reperfusion treatment; 58% coronary thrombolysis, and 3% primary percutaneous coronary intervention. The in-hospital mortality of patients with ST-elevation acute coronary syndromes was 10%, of patients with non-ST-elevation acute coronary syndromes 3%, and of patients with underdetermined electrocardiographic acute coronary syndromes 8%. At 6 months, the mortality rate increased to 16, 8, and 18%, respectively. CONCLUSIONS: Our data show the use of evidence-based pharmacological treatments in this population. This is associated with clinical outcomes which favorably compare with those observed in clinical trials. However, there is still room for improvement in the implementation of the invasive treatment.
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