Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry

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  ...

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Bibliographic Details
Published in:Heart (British Cardiac Society) 2006-11, Vol.92 (11), p.1571-1576
Main Authors: Heras, M, Bueno, H, Bardají, A, Fernández-Ortiz, A, Martí, H, Marrugat, J
Format: Article
Language:English
Subjects:
ACE
Acute coronary syndromes
Aged
Angina pectoris
angiotensin-converting enzyme
Anticoagulants - therapeutic use
Biological and medical sciences
Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines
Cardiology. Vascular system
Cardiotonic Agents - therapeutic use
Cardiovascular Medicine
Coronary Disease - mortality
Coronary Disease - therapy
Coronary heart disease
CRUSADE
DESCARTES
Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español
Female
FRagmin and Fast Revascularisation during InStability in Coronary artery disease
FRISC II
Global Registry of Acute Coronary Events
GRACE
Heart
Heart attacks
Hospitalization - statistics & numerical data
Humans
Male
Medical sciences
Mortality
Myocardial Revascularization - utilization
non-ST elevation acute coronary syndromes
NSTEACS
PCI
PEPA
percutaneous coronary intervention
Proyecto de Estudio del Pronostico de la Angina
Registries
Risk Factors
Spain - epidemiology
Survival Analysis
Citations: Items that cite this one
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Summary: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.
ISSN:1355-6037
1468-201X
DOI:10.1136/hrt.2005.079673