Changes of Treatment of Patients With Non-ST Elevation Acute Coronary Syndrome in Clinical Practice During Recent Several Years (Data From a Series of the Russian RECORD Registries)

Abstract

Erlikh A. D. on Behalf of Participants of the RECORD Registers.

Purpose: to assess changes in the management of patient with Non-ST Elevation (NSTE) Acute Coronary Syndrome (ACS) which occurred in Russian hospitals during recent several years by means of comparing data from a series ofACS registries RECORD - “old” (RECORD and RECORD-2, 2007-2011) and “new” (RECORD-3, 2015).

Results. Numbers of included patients with NSTEACS were 1502 and 1485 in then “new” and “old” registries, respectively. “New” registry compared with “old” comprised more women (44 and 37%, respectively, p=0.0001). Portions of patients aged ≥ 65 years were not statistically different (51 and 47%, respectively, р=0.57). Time from onset of symptoms to hospital admission was longer (7.7 and 4.8 hours, р<0.0001), portion of patients hospitalized in invasive hospitals - higher (67 and 42%, р<0.0001), frequency of troponin level determination - higher (72 and 45%, р<0.00001), frequency of coronary angiography (CA) - higher (48 and 30%, р<0.0001), and of percutaneous coronary interventions (PCI) - higher (21 and 15%, p<0.0001) in the “new” than “old” registries. In invasive hospitals rates of CA, PCI during hospital stay, frequencies of detection of stenoses ≥ 50%, and rates of coronary stenting in the “new” and “old” registries were not statistically different. Rate of PCI during first 72 hours in patients with coronary stenoses ≥ 50% was higher in the “new” registry (48 and 40%, respectively, р=0.013). During hospital stay patients in the «new» registry significantly more rarely received acetylsalicylic acid, parental anticoagulants, nitrates, and more often - dual antiplatelet therapy (DAPT), fondaparinux, statins; while at hospital discharge they were more rarely prescribed β -adrenoblockers, nitrates, and more often - DAPT, statins. Rates of death in “new” and “old” registries were not significantly different (2.5 and 3.4%, respectively, р=0.11) while sum of unfavorable outcomes (deaths + new myocardial infarctions) during hospital stay in the “new” registry was smaller (3.7 and 5.2%, respectively, р=0.042). Median length of inhospital treatment was 10.0 and 13.0 days (p<0.0001), portion of patients transferred from noninvasive hospitals for CA was 12.2 and 1.6% (р<0.0001) in “new” and “old” registries, respectively.

Conclusion. Main changes in management of patients with NSTEACS occurring between conduct of “old” and “new” registries RECORD became more frequent hospitalization in invasive hospitals and transferal from noninvasive hospitals for coronary angiography, more frequent determination of troponin, use of DAPT. With this rate of invasive coronary procedures was not sufficiently increased and remained relatively low.