Srpski Arhiv za Celokupno Lekarstvo (Jan 2007)
Clinical characteristics, management and mortality in patients with acute coronary syndrome from 2002 to 2005: Report from the National registry of acute coronary syndrome in Serbia
Abstract
Introduction Data regarding patients with acute coronary syndrome (ACS) did not exist in Serbia until 2002. By establishing the National Registry for Acute Coronary Syndrome (NRACS), the data collection based on the filled-in "coronary questionnaire" for each patient hospitalized and diagnosed with acute infarction of the myocardium (AIM) and unstable angina pectoris (UAP) was initiated in Serbia. Objective The aim of the study was to analyze clinical characteristics, complications, applied reperfusion-thrombolytic treatment and standard therapy, and mortality rate of patients treated in coronary or intensive care units during the 2002, 2003, 2004 and 2005. Method We chose a "coronary protocol" with minimal set of the patient’s data that was filled-in by the attending physician. The collection of the data was initiated in July 2002. Results During four months of 2002, 4202 patients were treated for ACS; in 2003 12739 patents, in 2004 12351 patients and 12598 patients in 2005. AIM with ST elevation (STAIM), as related to AIM without ST elevation (NSTAIM), was more often encountered in Serbian population in comparison to other European countries: in 2002, it was registered among 52.3% of patients, in 2003 among 52.7%, in 2004 among 51.8%, and in 2005 among 50.7% of patients. The patients suffering from the ACS in Serbia were of younger age, with a significant prevalence of females, as compared to the data from the European countries. Thrombolytic therapy in STAIM was applied in only 24.5% of patients in 2002, which then rose by each year, to reach 36.4% of patients in 2005. At the same time, as expected, hospital mortality rate decreased: from 14.8% in 2002 to 8.2% in 2005. STAIM patients untreated by thrombolytic therapy had a considerably higher mortality rate: in 2002 it was 20.3%, in 2003 15.3%, in 2004 14.3%, and in 2005 13.8%. Total mortality rate in patients with STAIM gradually decreased from 19% in 2002 to 11.7% in 2005. Conclusion From 2002-2005, the patients treated for ACS in Serbia were younger, with higher prevalence of females, and with a higher incidence of STAIM in relation to NSTAIM. The administration of reperfusion therapy in STAIM patients has been increasing significantly, from 24.5% in 2002 to 36.4% in 2005, and was followed by a decrease in hospital mortality rate of 14.8% in 2002 to 8.2% in 2005. Overall mortality of STAIM patients treated with or without thrombolytic therapy gradually decreased from19% in 2002 to 11.7% in 2005.
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