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ACCESS: Acute coronary syndromes (ACS) in Africa, middle-east and latin america: the access registry

Acute Coronary Syndromes



Sobhy, Mohamed (Egypt)

see Discussant report


List of Authors:


  • Prospective observational multinational registry hospitalized for an ACS with follow-up.
  • 134 sites in 19 countries in Latin America, middle east, north and south Africa.
  • 9732 ACS patients with one year follow-up.
  • 45% STEMI and 52% NSTEMI.
  • NSTEMI older, more females, more rate of medical history and risk factors.
  • All causes of death at 12 months, 7.3% more in STEMI, higher in Latin America, lowest in south Africa and middle east.
  • Main Factors were associated with 12 months death are cardiac arrest, cardiogenic shock, Stroke, TIAs and age > 70 years.
  • No reperfusion in STEMI 60% fibrinolytic in 30% primary PCI 26%.
  • Use of evidence- based pharmacological therapies for ACS was quite high but reperfusion rate for STEMI (40%) were disappointingly low.
  • These finding suggest opportunities to reduce the risk of long term ischaemic events in ACS patients in developing countries .

Summary of Access Registry

  • 9732 ACS patient with one year follow-up in Latin America, middle east, north and south Africa as prospective observational multinational registry.
  • 45% STEMI and 52% NSTEMI.
  • All cause of death at 1 year 7.3% in STEMI, higher in Latin America, Lowest in south Africa and middle east.
  • Use of pharmacological therapies for ACS was quite high, but reperfusion rates of STEMI 40% were disappointingly low.
  • Main factors were associated with 12months death are cardiac arrest, cardiogenic shock, stroke, TIAs and age more than 70 years.
  • These suggest opportunities to reduce further the risk of long term ischaemic events in ACS patient in developing countries.


Lopez-Sendon, Jose

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

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.