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Sobhy, Mohamed (Egypt)
see Discussant report
List of Authors:
Summary of Access Registry
Lopez-Sendon, Jose (Spain)
see Presenter abstract
The ACCESS registry is a multinational initiative to describe de epidemiology, practice patterns and primary outcomes 12.000 patients with ACS in Latin America, Middle East and North and South Africa. This represents an extraordinary effort of collaboration between countries without any apparent relationship except, perhaps, that have not participated in many multicenter registries and epidemiological as well as demographic, treatment strategies and outcome data is much needed. Interestingly, the demographics and risk factor were very similar to the population from contemporary registries in Europe and North America; 75% men of whom 21% were over 70 years, 23% previous myocardial infarction, 35% diabetics, 35% overweight and 40% current smokers. Also interestingly guideline recommended medications were frequently used: 93% were given aspirin, 75% thienopyridines, 90% statins, 76% beta-blockers 68% ACE-I and the majority received some antithrombotic therapy. Primary PCI in STEMI was performed in 26% (94% stents, 39% drug eluting stents); 39% received fibrinolytic therapy, but 60% did not received reperfusion therapy at all. This is in contrast with clinical practice in European countries where reperfusion therapy is more frequently used and the preferred choice is mechanical revascularization. Outcomes were reported for a total follow-up of 1 year. Mortality was 7.3, varying from 5.7% in South Africa to 8.3 in Latin America, a mortality rate lower than that reported in European registries and the combined outcomes including CV death, re-infarction, stroke or re-hospitalization at 12 months was very low (17%). Curiously, mortality was higher in STEMI than in NST- ACS. The registry presents several limitations: was not population based, it is not clear how the hospitals were selected, if consecutive or random patients were selected for the registry, diagnostic criteria were not as restrictive as in other registries, overall risk profile of the population was not calculated, quality controls are not described, and it is not clear if the follow-up was prospective and successful. In spite of these limitation, the registry provides important scientific data, identifies opportunities for treatment improvement and the investigators must be congratulated for an extraordinary effort overcoming important barriers and should be encouraged to continue the collaboration in the future.
710005 - 710006
Clinical Trial Update II
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