Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies

doi:10.1016/j.ahj.2011.07.029

American Heart Journal

Volume 162, Issue 5, November 2011, Pages 852-859.e22

https://doi.org/10.1016/j.ahj.2011.07.029 Get rights and content

Background

The burden of cardiovascular diseases is predicted to escalate in developing countries. We investigated the descriptive epidemiology, practice patterns, and outcomes of patients hospitalized with acute coronary syndromes (ACS) in African, Latin American, and Middle Eastern countries.

Methods

In this prospective observational registry, 12,068 adults hospitalized with a diagnosis of ACS were enrolled between January 2007 and January 2008 at 134 sites in 19 countries in Africa, Latin America, and the Middle East. Data on patient characteristics, treatment, and outcomes were collected.

Results

A total of 11,731 patients with confirmed ACS were enrolled (46% with ST-elevation myocardial infarction [STEMI], 54% with non–ST elevation–ACS). During hospitalization, most patients received aspirin (93%) and a lipid-lowering medication (94%), 78% received a β-blocker, and 68% received an angiotensin-converting enzyme inhibitor. Among patients with STEMI, 39% did not receive fibrinolysis or undergo percutaneous coronary intervention. All-cause death at 12 months was 7.3% and was higher in patients with STEMI versus non–ST elevation–ACS (8.4% vs 6.3%, P < .0001). Clinical factors associated with higher risk of death at 12 months included cardiac arrest, antithrombin treatment, cardiogenic shock, and age >70 years.

Conclusions

In this observational study of patients with ACS, the use of evidence-based pharmacologic therapies for ACS was quite high, yet 39% of eligible patients with STEMI received no reperfusion therapy. These findings suggest opportunities to further reduce the risk of long-term ischemic events in patients with ACS in developing countries.

Section snippets

Methods

ACCESS is a prospective, observational, multinational registry of patients hospitalized for an acute coronary event. Patients were enrolled at 134 sites in 19 countries in North Africa (Algeria, Morocco, and Tunisia), South Africa, Latin America (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, and Venezuela), and the Middle East (Egypt, Iran, Jordan, Kuwait, Lebanon, Saudi Arabia, and United Arab Emirates).

The ACCESS registry was conducted in accordance with the

Results

Between January 2007 and January 2008, 12,068 patients were recruited by 467 physicians (58.7% were noninterventional cardiologists, 26.8% interventional cardiologists, 7.3% internists, 3.6% hospital physicians, and 3.6% other physicians).

Discussion

We report on the contemporary management and long-term outcomes for almost 12,000 patients with ACS in developing countries. Patients with STEMI tended to be slightly younger than those with NSTE-ACS, with a higher proportion of men, fewer risk factors, and a less frequent history of cardiac disease; they were, however, more often smokers and heavy drinkers and had a higher 12-month all-cause mortality rate (8.4% vs 6.3%).

In terms of ACS types, patients in ACCESS were broadly similar to those

Acknowledgements

Sophie Rushton-Smith, PhD, provided medical writing assistance in the preparation of this report and was funded by Sanofi-Aventis.

Steering Committee

Gilles Montalescot (principal investigator) (France), Norka Antepara (Venezuela), Alvaro Escobar (Colombia), Samir Alam (Lebanon), Alain Leizorovicz (France), Carlos Martinez (Mexico), José Nicolau (Brazil), and Mohamed Sobhy (Egypt).

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A total of 1396 STEMI patients were included. Cox proportional hazards models were used to determine the association between hyperuricemia and 1-year all-cause mortality in the overall population and subgroups stratified based on LDL-c levels (<3.0 mmol/L or ≥3.0 mmol/L). Multivariate analysis indicated that hyperuricemia was associated with 1-year mortality (HR: 2.66; 95% CI: 1.30–5.47; p = 0.008). However, the prognostic effect of hyperuricemia was only observed in patients with LDL-c level ≥3.0 mmol/L (HR: 12.90; 95% CI: 2.98–55.77; p < 0.001), but not in those with LDL-c level <3.0 mmol/L (HR: 0.91, 95% CI: 0.30–2.79, p = 0.875). The interaction between hyperuricemia and LDL-c levels had a significant effect on 1-year mortality.
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Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330).
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View all citing articles on Scopus

^a: See online Appendix A for a complete listing of ACCESS Investigators.

^b: E-mail: [email protected]; [email protected]

View full text

Clinical InvestigationAcute Ischemic Heart DiseaseManagement of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgements

Lancet

Am J Med

Am Heart J

Am J Cardiol

Am Heart J

Lancet

Am Heart J

Am J Cardiol

Am Heart J

Int J Cardiol

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology

Eur Heart J

Guidelines for the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes

Eur Heart J

Prevention of chronic diseases: WHO global strategy on diet, physical activity and health

Food Nutr Bull

Regional and practice variation in adherence to guideline recommendations for secondary and primary prevention among outpatients with atherothrombosis or risk factors in the United States: a report from the REACH Registry

Crit Pathw Cardiol

Clinical Investigation
Acute Ischemic Heart Disease
Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies