Registry of acute coronary syndromes RECORD. Characteristics of patients and results of inhospital treatment
Erlikh, A.D.; Gratsianskiĭ, N.A.
Kardiologiia 49(7-8): 4-12
2009
ISSN/ISBN: 0022-9040 PMID: 19656100 Document Number: 631065
As contemporary information on real life management of hospitalized patients (pts) with acute coronary syndromes (ACS) in Russia is lacking we initiated limited ACS registry using no financial and no or minimal administrative support. REgistry of acute CORonary synDromes - RECORD is a participants-initiated internet based project which uses design and adapted documents of the ESC ACS Registry. Overall 18 hospitals from 14 cities of various Russian regions submitted required information. Centers were asked to include < or =50 consecutive pts admitted alive within 24 h after onset of symptoms during 1 month. Ten hospitals had possibilities to perform percutaneous coronary interventions (PCI). From 11.01.2007 to 10.02, 2008 we included 796 pts (men 57.2%, age 31-93, mean 64.7+/-12.1, 25% >75 years) with ST elevation (STE) (n=246) and non-ST elevation (NSTE) (n=550) ACS. Invasive centers registered 65.4 and 46.2% of STEACS and NSTE ACS pts, respectively. STEACS. Median time from symptoms onset to hospitalization was 4.33 h (interquartile range 2.17-9.58 h). Primary reperfusion was used in 127 pts (51.6%) (thrombolysis in 79 [32.1%], primary PCI in 46 [18.7%], both in 2 pts). Median time from admission to start of thrombolysis was 0.33 h (interquartile range 0.17-0.53 h), from hospitalization to "start of PCI" (start of procedure, not to balloon) 1.5 h (interquartile range 0.83 - 4.08 h). Aspirin during hospitalization was given to 93.9, clopidogrel - to 44.9% (1/5 without loading dose) of pts. Average duration of hospitalization was 13.9 days. Hospital mortality was 16.7%. NSTEACS. Median time from symptoms onset to hospitalization was 7.42 h (interquartile range 3-23.75 h). ST depression more or equal 1mm on admission ECG was registered in 29.5%. Cardiac troponin was measured at least ones in 43.5% of pts, in 22.9% no markers of myocardial necrosis were assessed. PCI was used in 11.4%, coronary bypass surgery in 5.8% of pts. Anticoagulants were used in 84.9% of pts (in 73.3% - unfractionated heparin). In hospital aspirin was given to 92.9, clopidogrel - to 27.6% (29.6% without loading dose) of pts. Average hospital stay was 12.4 days. Discharge diagnosis was myocardial infarction in 32, unstable angina - in 51.1, stable angina - in 8.2, "noncardiac disease" - in 8.6% of pts. Hospital mortality was 2.7%. Despite limited size RECORD represented wide scope of hospitals. It revealed obvious underuse of conventional treatments. In STEACS this was associated with high hospital mortality. In NSTEACS relatively satisfactory result could be explained by preponderance of unstable angina.