Cardiopatía isquémica
Manejo del síndrome coronario agudo sin elevación del segmento ST en España. Estudio DESCARTES (Descripción del Estado de los Síndromes Coronarios Agudos en un Registro Temporal ESpañol)Management of Non-ST-Segment-Elevation Acute Coronary Syndromes in Spain. The DESCARTES (Descripción del Estado de los Síndromes Coronarios Agudos en un Registro Temporal ESpañol) Study,☆☆

https://doi.org/10.1157/13072471Get rights and content

Introducción y objetivos

Se dispone de escasa información acerca de la situación asistencial a escala poblacional de los síndromes coronarios agudos sin elevación del segmento ST (SCASEST) en España. El objetivo es conocer la situación de la atención médica a los pacientes con SCASEST en España, desde una perspectiva representativa de la realidad estatal.

Pacientes y método

Registro prospectivo de pacientes consecutivos con SCASEST ingresados en 52 hospitales españoles con distintos recursos cardiológicos, seleccionados al azar y que cumplieron con los criterios de control de calidad del estudio.

Resultados

Entre abril y mayo de 2002 se reclutó a 1.877 pacientes con una edad promedio de 69 años. El 93% tenía algún factor de riesgo y 73% antecedentes cardiovasculares. Un 76% presentaba un electrocardiograma anormal y un 53% elevación de las troponinas. El 27% fue ingresado en una unidad coronaria o de cuidados intensivos. Se estudió al 56% de los pacientes mediante ecocardiografía, al 39% mediante una prueba de detección de isquemia y al 41% mediante coronariografía. En el hospital, un 88% recibió aspirina, un 81% heparina, un 37% clopidogrel, un 12% inhibidores de la glucoproteína IIb/IIIa, un 63% bloqueadores beta, un 46% inhibidores de la enzima de conversión de la angiotensina y un 52% estatinas. Se realizó revascularización coronaria en el 24% de los pacientes. El diagnóstico final fue angina en el 54%, infarto en el 28% y otros diagnósticos en el 18%. La mortalidad fue del 3,7% a los 28 días y del 7,8% a 6 los meses.

Conclusiones

DESCARTES es el primer registro representativo de la actividad asistencial en la atención a los SCASEST en España. Se demuestra que, pese a que son pacientes de alto riesgo, reciben una atención subóptima según lo recomendado.

Introduction and objectives

There is little information regarding the management of non-ST segment elevation acute coronary syndromes (NSTE ACS) in Spain from a population-based perspective. Our objective was to study the status of clinical care in patients with NSTE ACS in Spain from a representative perspective of the situation on a national level.

Patients and method

A prospective registry was used for consecutive patients with NSTE ACS admitted to 52 Spanish hospitals with different cardiological facilities. Centers that fulfilled the quality control criteria for the study were randomly selected for inclusion.

Results

Between April and May, 2002, 1877 patients were recruited. Median age was 69 years, 93% had at least one risk factor and 73% had antecedents of cardiovascular disease. The electrocardiogram on admission was abnormal in 76% of the cases, and troponin levels were elevated in 53%. Twenty-seven percent of the patients were admitted to a cardiac care unit or intensive care unit. The rates of use of diagnostic techniques were: echocardiography 56%; non-invasive test for detection of ischemia 39%; coronary angiography 41%. During hospitalization, 24% underwent coronary revascularization, 88% received aspirin, 81% heparin, 37% clopidogrel, 12% glycoprotein IIb/IIIa inhibitors, 63% ß-blockers, 46% angiotensin-converting enzyme inhibitors, and 52% statins. The final diagnosis was angina in 54%, myocardial infarction in 28%, and other in 18%. Mortality was 3.7% at 28 days and 7.8% at 6 months.

Conclusions

DESCARTES is the first representative registry of NSTE ACS management in Spain. It shows that despite their high-risk profile, these patients receive suboptimal medical care according to current clinical recommendations.

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En el anexo se relacionan los investigadores y hospitales participantes en el estudio DESCARTES

☆☆

El estudio DESCARTES fue promovido por la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología con la colaboración de Bristol-Myers Squibb, a través de una beca no condicionada.

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