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23-11-2011 | Cardiology | Article

Management of ACS in developing countries ‘must be improved’


Free abstract

MedWire News: The interventional management of acute coronary syndromes (ACS) in developing countries must be improved, says a team of French researchers.

Although the 12-month ACS mortality rate in developing countries compares favorably with that of developed Western countries, interventional management is more conservative, report Gilles Montalescot (Universitaire Pitie-Salpêtière, Paris) and team.

"These data highlight opportunities to increase the use of evidence-based medications and interventions, including more extensive use of reperfusion therapy, in an effort to reduce long-term adverse outcomes," they write in the American Heart Journal.

The researchers conducted a prospective observational study of 11,731 individuals aged 21 years or over who were hospitalized with a diagnosis of ACS between 2007 and 2008. Patients were recruited at 134 sites in 19 countries in Africa, Latin America, and the Middle East.

The researchers used questionnaires to collect data on patient characteristics, treatment, and outcomes. They followed-up patients for 1 year.

Overall, 46% of the patients had ST segment-elevation myocardial infarction (STEMI) and 54% had non-ST segment-elevation ACS (NSTEACS).

During hospitalization, the most commonly used medications were aspirin (93%), statins or other lipid-lowering drugs (94%), thienopyridines (81%), and beta-blockers (78%), with little difference in usage between STEMI and NSTEACS patients.

Among patients with STEMI, 39% did not receive any form of acute reperfusion therapy (percutaneous coronary intervention or fibrinolysis) within 24 hours of admission.

At the 12-month follow-up, the rate of all-cause mortality was 7.3%, and was significantly higher in patients with STEMI than those with NSTEACS, at 8.4% versus 6.3% (p<0.0001).

In a survival analysis based on 9732 ACS patients, the four factors most significantly associated with an increased risk for mortality at 12 months were cardiac arrest during hospitalization, receipt of antithrombotic treatment, cardiogenic shock, being older than 70 years of age, and stroke or transient ischemic attack during index hospitalization.

The authors conclude: "By examining patterns of use of evidence-based treatments and interventional approaches and providing feedback to healthcare physicians, these data may play a role in ongoing efforts to improve the future of patients with ACS in developing countries."

By Piriya Mahendra

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