Guideline Compliance in the Management of Patients with Unstable Angina/Non-STEMI without PCI Procedure (Medically Managed Registry)

Abstract

Aim: To document current usage of antiplatelet therapy and the implementation of ACC/AHA 2007 guideline in the clinical management of unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients not undergoing PCI procedure in Indonesia (medically managed) and their risks according to Global Registry of Acute Coronary Events (GRACE) score as well as in-hospital mortality. Method: A multicenter observational, prospective disease registry, recruiting patients with UA/NSTEMI. No specific treatment will be recommended in this disease registry. Data will be collected based on Physicians applicable daily practices without any intervention. Results: A total of 467 eligible patients, 246 patients with UA and 221 with NSTEMI, aged 18 years or older were recruited from 18 hospitals during December 2009 January 2011. Most recruited patients were at low risk (63.9%) and only 0.9% patients were at high risk according to the GRACE score. Patients were treated with ASA (90.6%) and Clopidogrel (96.6%) when they reached the emergency department. Medical therapy instituted during hospitalization were injectable anticoagulant (91.4%), oral anticoagulant (0.9%), oral nitrate (82.7%), beta blocker (60.8%), ACE inhibitor (49%), angiotensin receptor blocker (20.3%), calcium channel blocker (19.9%), statin (13.1%), and other medications given according the presentation of complications or comorbidities. In-hospital mortality was documented in 3.2% of patients. At discharge ASA was given to 87.6% and clopidogrel to 94.2% patients. Conclusion: The result showed that most of the patients admitted with UA/NSTEMI were at low or moderate risk according to GRACE score. Although treatment with antiplatelet and anticoagulant largely followed the ACC/AHA guidelines, however, this registry documented under treatment of other medications such as ACE-inhibitors and beta blockers. Reinforcement of the guideline compliance and continuous medical education would provide better outcomes for the patients.

Keywords

• UA / NSTEMI
• Registry
• Medically Managed