Aim: To characterize the state of prehospital management of patients with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized patients with ACS.
Methods: The registry included data on consecutive patients with ACS admitted to coronary care units or their equivalents of participating hospitals within 24 hours after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 PCI capable or "invasive") city hospitals officially treating ACS patients. Data concerning prehospital stage was collected by hospital physicians.
Results: Among 584 patients included in the registry 88.8% were brought by ambulances. Time (median) from onset of symptoms to call for medical aid was 2.4 h, to hospitalization - 4.3 h, from call for medical aid to hospitalization--1.6 h. Calculated approximate time of contact of ambulance staff with patient at site of attack (the latter time minus official time to arrival and transportation time) was more than 50 min. Referral diagnoses were myocardial infarction (MI) in 29.3, unstable angina in 48.4, other acute conditions in 22.3% of patients. Among patients referred as unstable angina about 49% were diagnosed as MI during hospitalization. Referral diagnosis of ambulance physicians did not appear among independent predictors of inhospital death or new MI (ST depressions, Killip class > or = ll, high GRACE score). Rate of prehospital thrombolysis was 8.0% among all patients diagnosed in hospital as ST elevation (STE) ACS (10.8% among STEACS patients admitted within 12 h of symptoms). There were significantly less patients older than 65 years among those subjected compared with not subjected to prehospital thrombolysis (23.1% vs. 59.6%, respectively; p = 0.024). Clopidogrel (mostly 300 mg) and recommended loading dose of aspirin were given to 70.9 and 51% of patients, respectively. Unfractionated heparin and enoxaparin were given to 49.4 and 7.5% of all patients, respectively. Inhospital bleeding rate was significantly higher in patients phehospitally treated with anticoagulants.
Conclusion: The following characteristics of prehospital management of patients diagnosed as ACS at hospital (CCU) admission could be object of improvement: long time of contact of ambulance staff with patients; attempts to diagnose (exclude) MI associated with unjustified referral to noninvasive hospitals; preferential use of thrombolysis in younger patients; relatively rare use of guideline recommended doses of aspirin and clopidogrel. Of note is association of inhospital bleedings with prehospital administration of anticoagulants.