Original articlePrognosis and Management of Acute Coronary Syndrome in Spain in 2012: The DIOCLES StudyPronóstico y manejo del síndrome coronario agudo en España en 2012: estudio DIOCLES
Section snippets
INTRODUCTION
Acute coronary syndrome (ACS) is the main complication of ischemic heart disease and has considerable health impact.1, 2 In Spain, several ACS registries3, 4, 5, 6, 7 have investigated the prognosis and management of the condition and its clinical course over time.8
The MASCARA study7 included patients from 2004 to 2005 and is the last of these large registries. Since then, ACS management has seen several changes, such as the widespread use of reperfusion therapies for ST-segment elevation ACS
Study Design
This multicenter, observational, cross-sectional study prospectively collected admission data and performed 6-month follow-up among patients ≥ 18 subsequently admitted for suspected ACS that was first managed at the participating site (except prehospital treatment or admission a few hours after primary PCI at another site) and who gave written consent. Consent was not required to analyze cases of in-hospital death. Patients were excluded if ACS was secondary to other processes, such as
Baseline Characteristics and Clinical Presentation
The study included 44 sites in 13 autonomous communities (all except for Balearic Islands, Canary Islands, Castile-LaMancha, and La Rioja, which are not represented because no hospitals in these communities were selected at random or due to administrative delays). A total of 3059 patients were assessed, and 502 of these were excluded for the reasons described in Figure 1. Therefore, the study included 2557 patients: 788 (30.8%) with an admission diagnosis of STEACS, 1602 (62.7%) with NSTEACS,
DISCUSSION
In this registry, the in-hospital mortality of patients admitted to Spanish hospitals for suspected ACS was 4.1%, a significantly lower figure than that reported in the last registry available.7 Additionally, an increase was observed in the use of recommended treatments, such as reperfusion in STEACS, coronary angiography and revascularization in NSTEACS, and secondary-prevention therapies at discharge.
CONCLUSIONS
The mortality of patients with ACS in Spain has dropped compared with the mortality reported by the last available registry, in keeping with a more frequent use of recommended treatments, such as reperfusion, revascularization, and secondary prevention measures. Several aspects, particularly time to reperfusion in STEACS, are less than optimal.
FUNDING
This study was funded by an unrestricted grant from Daiichi-Sankyo-Lilly.
CONFLICT OF INTERESTS
None declared.
ACKNOWLEDGMENTS
The authors acknowledge assistance from the Daiichi Sankyo/Lilly alliance to conduct this study.
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