- Acute Coronary Syndrome Snapshot Survey - from 7 to 13 December 2009
- Acute Coronary Syndromes Registry - 1 year follow-up will be completed in December 2009
- Acute Coronary Syndromes II (ACS II)- Completed in 2004
- Acute Coronary Syndromes I (ACS I)- Completed in 2000
Based on the experience of the previous projects, the ACS-Registry is the first continuous registration of consecutive patients presenting with ACS in Europe providing benchmark reports on key performance indicators for quality assurance with the intention to improve the implementation of ESC guidelines into clinical practice.
The first survey on Acute Coronary Syndromes (ACS-I) included 10,484 patients with a discharge diagnosis of ACS.
These patients were enrolled during 2000-2001 in 103 hospitals from 25 countries.
ACS I: Main publication (PDF, 180k)
Euro Heart Survey ACS II was carried out in 2004 and included 6,385 patients from 190 hospitals in 32 countries with a final diagnosis of ACS.46
ACS II: Main publication (PDF, 119k)
Of the 25 countries participating in ACS-I, 23 also participated in ACS-II.
Among the 190 hospitals participating in ACS-II were 34 hospitals that had also participated in ACS-I.
Type of ACS was fairly comparable between ACS-I and ACS-II with 42% and 47%
having ST elevation. In both surveys mean age was 65 years and just over two-third
were men. Comorbid conditions were also fairly comparable between the two surveys, although prior MI was less often present in ACS-II patients (16% vs. 22% in ACS-I).
Primary reperfusion therapy in patients with ST elevation myocardial infarction (STEMI) was provided more often in ACS-II (64% vs. 56% in ACS-I), with a larger proportion receiving primary PCI (37% of patients; 59% of reperfusion therapy). Time between symptom onset and arrival at the emergency room (ER) was shorter in ACS-II (145 vs. 176 minutes in ACS-I), and also the time period between ER and reperfusion by primary PCI was shorter in ACS-II (70 minutes vs. 93 in ACS-I). The major reasons for not providing primary reperfusion therapy in 36% of ACS-II patients were late arrival (30%), uncertain diagnosis (11%), early resolution of ST-elevation (12%), and contraindications (7%).
From 2000 to 2004 the application of coronary interventions in STEMI patients increased. Coronary angiography (CAG) was performed in 70% of ACS-II patients compared to 56% in ACS-I. An increasing number patients received a percutaneous coronary intervention (PCI) (40% in ACS-I; 58% in ACS-II), and the proportion of patients receiving stents increased from 31% in ACSI to 52% in ACS-II. The increase in the proportion of patients undergoing CAG, PCI, and stent implantation among those hospitalised in the 34 centres that participated in both ACS-I and ACS-II was even greater than in the full ACS-I and ACS-II cohorts.
In patients with non ST elevation (Non STE) ACS the application of coronary interventions also increased between ACS-I and ACS-II. A higher number of patients was referred for CAG (52% in ACS-I to 63% in ACS-II), an increasing number patients received PCI (25% in ACS-I to 37% in ACS-II), and also stenting was applied more often (18% in ACS-I to 34% in ACS-II).
The prescription rate of discharge medication increased between the ASC-I and ACS-II surveys. Antiplatelets, beta-blockers, ACEinhibitors, statins and clopidogrel were allprescribed more frequently. A relatively high increase was observed for statins (from 53% in ACS-I to 80% in ACS-II) and the prescription rate of clopidogrel even doubled from 29% in ACS-I to 61% in ACS-II. 30-day mortality in Non STE ACS patientsremained similar between ACS-I and ACS-II (3.5% to 3.4%), and decreased in STE ACS patients from 8.4% to 6.4%.
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