Prognosis and management of acute coronary syndrome in Spain in 2012: the DIOCLES study

Abstract

Introduction and objectives: To identify the current mortality and management of patients admitted for suspected acute coronary syndrome in Spain. The last available registry (2004-2005) reported an in-hospital mortality of 5.7%.

Methods: The study included patients consecutively admitted between January and June 2012 at 44 hospitals selected at random. Information was collected on clinical course at admission and on events at 6 months.

Results: A total of 2557 patients admitted with suspected acute coronary syndrome were included: 788 (30.8%) with ST-segment elevation, 1602 (62.7%) without ST-segment elevation, and 167 (6.5%) with unclassified acute coronary syndrome. In-hospital mortality was 4.1% (6.6%, 2.4%, and 7.8% respectively), significantly lower than that observed for 2004-2005. Reperfusion treatment (most commonly, primary percutaneous coronary intervention) was administered to 85.7% of patients with ST-segment elevation attended within 12h. The median time from first medical contact to thrombolysis was 40 min and to balloon inflation, 120 min. Among patients without ST-segment elevation, coronary angiography was performed in 80.6%, percutaneous intervention in 52.0%, and surgery was indicated in 6.4%. Secondary prevention treatments at discharge was prescribed more often than in earlier registries. In patients alive at discharge (follow-up available for 97.1%), 6-month mortality was 3.8%.

Conclusions: Mortality among patients with acute coronary syndrome in Spain was lower than that reported in the most recent published studies, in parallel with a more frequent use of the main treatments recommended.

Keywords: Angina inestable; Infarto de miocardio; Myocardial infarction; Prognosis; Pronóstico; Registro; Registry; Supervivencia; Survival; Unstable angina.