Heim Inge, Jonke Vladimir, Gostović Mladen, Jembrek-Gostović Mirjana
Polyclinic for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia.
Acta Med Croatica. 2009 Feb;63(1):105-9.
Amongst cardiovascular diseases (CVD), acute coronary syndrome (ACS) is an important cause of cardiovascular mortality. The aim of the study was to examine ACS in Zagreb, to determine how it is treated, and to assess the extent to which new guidelines have been implemented in daily practice. During the last decades, great improvements have been made in the prevention and management of ACS. We wished to ascertain how these improvements have been implemented in our hospitals in the year 2003.
We carried out a retrospective study including patients in the City of Zagreb that had been discharged from the hospital with the diagnosis of ACS. The community-based Registry of Acute Coronary Syndrome for the City of Zagreb for the year 2003 served as the source of data. Records on 1,733 ACS patients were analyzed. In 1,349 hospitalized patients, the following parameters were investigated: length of hospital stay; time from onset of symptoms to arrival in hospital; rate of angiography and reperfusion and medical therapy after discharge.
Study results showed that 1,105 (64%) patients were discharged from hospital, 244 (14%) died in hospital, and 384 (22%) died outside hospital. There were 1,136 (84%) patients with AMI, 638 (56%) with ST segment elevation MI, 391 (34%) with non-ST segment elevation MI and 107 (10%) of patients with possible MI and MI with undetermined ECG. Patient records revealed that 688 (51%) stayed in hospital between 8 and 14 days. The time from symptom onset to hospital arrival was less than 6 hours in 566 patients, 349 (44%) men and 217 (39%) women; 6 to 12 hours in 157 patients, 79 (10%) men and 78 (14%) women; and over 12 hours in 410 patients, 238 (30%) men and 172 (31%) women. The time of symptom onset was unknown in 216 patients, 127 (16%) men and 89 (16%) women. Angiography and reperfusion therapy were performed in 557 (41%) patients, 373 (47%) men, and 184 (33%) women; PCI/PCI + stent in 33% of men with ST or non-ST segment elevation, and 25% of women with ST segment elevation and 19% of women with non-ST segment elevation. Fibrinolytic therapy was performed in 86 patients, 53 (7%) men and 30 (5%) women. Amongst ACS patients (N=966), 85% took aspirin, 70% beta-blockers, 69% angiotensin converting enzyme inhibitors and 63% statins.
Compared to other studies, non-ST segment elevation MI and unstable angina seemed to be less often diagnosed. Patients arrived in hospital rather late after symptom onset, and this was probably one of the reasons that reperfusion therapy could not be sufficiently applied. We also noted that physicians did not always follow the generally accepted guidelines to enable a better outcome by use of preventative measures and higher rate of effective therapy. There are important lessons to be learnt from this study for both patients and physicians.
在心血管疾病（CVD）中，急性冠状动脉综合征（ACS）是心血管疾病死亡的重要原因。本研究的目的是对萨格勒布的急性冠状动脉综合征进行调查，确定其治疗方式，并评估新指南在日常实践中的实施程度。在过去几十年中，急性冠状动脉综合征的预防和管理取得了巨大进展。我们希望确定这些进展在2003年我们医院是如何实施的。
我们进行了一项回顾性研究，纳入了从萨格勒布市医院出院、诊断为急性冠状动脉综合征的患者。2003年萨格勒布市基于社区的急性冠状动脉综合征登记册作为数据来源。对1733例急性冠状动脉综合征患者的记录进行了分析。在1349例住院患者中，调查了以下参数：住院时间；从症状发作到入院的时间；血管造影和再灌注率以及出院后的药物治疗。
研究结果显示，1105例（64%）患者出院，244例（14%）在医院死亡，384例（22%）在院外死亡。有1136例（84%）患者为急性心肌梗死，638例（56%）为ST段抬高型心肌梗死，391例（34%）为非ST段抬高型心肌梗死，107例（10%）为可能的心肌梗死和心电图未明确的心肌梗死患者。患者记录显示，688例（51%）住院8至14天。566例患者从症状发作到入院的时间少于6小时，其中男性349例（44%），女性217例（39%）；157例患者为6至12小时，其中男性79例（10%），女性78例（14%）；410例患者超过12小时，其中男性238例（30%），女性1
