How “Real Life” Treatment of Patients With ST-Elevation Acute Coronary Syndrome Has Changed During Recent Several Years (Data From a Series of the Russian RECORD Registries)

Purpose: to assess changes in the management of patient with ST-Elevation (STE) Acute Coronary Syndrome (ACS) which occurred during recent several years by means of comparing data from the series of Russian ACS registries RECORD - “old” (RECORD and RECORD-2, 2007-2011) and “new” (RECORD-3, 2015). Results. Numbers of included patients were 967 and 868, proportion of invasive centers - 56 and 55% in “old” and “new” registries, respectively. Most anamnestic characteristics of both populations (of old registries group and the new registry) were similar. In RECORD-3 compared with old registers level of troponins was significantly more often determined, median time from symptoms onset until seeking medical help and until hospitalization was higher, and significantly more patients were transferred directly to catheterization laboratory. TTere were no significant differences in rates of primary percutaneous interventions (PCI) and use of thrombolytic therapy (TLT) between “old” registries and RECORD-3: 36.3 vs. 39.0% (р=0.24), 32.2 vs. 32.1% (p=0.98), respectively. However, compared with RECORD (2007-2008) rates of primary PCI, prehospital TTL, use of pharmacoinvasive approach, and any PCI during hospitalization in RECORD-3 were significantly higher: 20 vs. 39% (р<0.0001), 24 vs. 51% (p<0.0001), 25 vs. 52% (р<0.0001), 47 vs. 55% (p=0.0009), respectively. Patients in RECORD-3 during hospitalization significantly more often received dual antiplatelet therapy, enoxaparin, fondaparinux, statin, but significantly less often they were given aspirin, intravenous unfractionated heparin, IIb/IIIa receptor blockers, nitrates, and loop diuretics. Rates of mortality as well as sums of the following events: “death + myocardial infarction [MI]”, “death + MI + stroke” in RECORD-3 and “old” registries did not differ significantly: 9.8 vs. 11.4% (р=0.27), 12.4 vs. 14.6% (р=0.18), 13.0 vs. 15.2% (р=0.18), respectively. But rate of new MIs during hospitalization in RECORD-3 was significantly lower: 3.5 vs. 5.8% (p=0.019). Conclusion. Russian ACS registry RECORD-3 revealed some improvement of treatment of patients with NSTEACS compared with older registries RECORD and RECORD-2. However, there were no significant changes of primary PCI, TLT rates, and of hospital mortality, while rate of inhospital MIs significantly decreased.

регистр, острый коронарный синдром, РЕКОРД, подъем сегмента ST, ST- elevation acute coronary syndrome, treatment, registry

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