Am Heart J. 2011 Nov;162(5):852-859.e22. doi: 10.1016/j.ahj.2011.07.029.
The burden of cardiovascular diseases is predicted to escalate in developing countries. We investigated the descriptive epidemiology, practice patterns, and outcomes of patients hospitalized with acute coronary syndromes (ACS) in African, Latin American, and Middle Eastern countries.
In this prospective observational registry, 12,068 adults hospitalized with a diagnosis of ACS were enrolled between January 2007 and January 2008 at 134 sites in 19 countries in Africa, Latin America, and the Middle East. Data on patient characteristics, treatment, and outcomes were collected.
A total of 11,731 patients with confirmed ACS were enrolled (46% with ST-elevation myocardial infarction [STEMI], 54% with non-ST elevation-ACS). During hospitalization, most patients received aspirin (93%) and a lipid-lowering medication (94%), 78% received a β-blocker, and 68% received an angiotensin-converting enzyme inhibitor. Among patients with STEMI, 39% did not receive fibrinolysis or undergo percutaneous coronary intervention. All-cause death at 12 months was 7.3% and was higher in patients with STEMI versus non-ST elevation-ACS (8.4% vs 6.3%, P < .0001). Clinical factors associated with higher risk of death at 12 months included cardiac arrest, antithrombin treatment, cardiogenic shock, and age >70 years.
In this observational study of patients with ACS, the use of evidence-based pharmacologic therapies for ACS was quite high, yet 39% of eligible patients with STEMI received no reperfusion therapy. These findings suggest opportunities to further reduce the risk of long-term ischemic events in patients with ACS in developing countries.
心血管疾病的负担预计在发展中国家会加重。我们调查了非洲、拉丁美洲和中东国家因急性冠脉综合征（ACS）住院的患者的描述性流行病学、治疗模式和结局。
在这项前瞻性观察性登记研究中，2007 年 1 月至 2008 年 1 月期间，在非洲、拉丁美洲和中东的 19 个国家的 134 个地点，共招募了 12068 名诊断为 ACS 的成年患者。收集了患者特征、治疗和结局的数据。
共纳入 11731 例确诊 ACS 患者（46%为 ST 段抬高型心肌梗死 [STEMI]，54%为非 ST 段抬高型 ACS）。住院期间，大多数患者接受了阿司匹林（93%）和降脂药物（94%），78%接受了β受体阻滞剂，68%接受了血管紧张素转换酶抑制剂。在 STEMI 患者中，39%未接受溶栓或经皮冠状动脉介入治疗。12 个月时的全因死亡率为 7.3%，STEMI 患者高于非 ST 段抬高型 ACS 患者（8.4% vs 6.3%，P<0.0001）。12 个月时死亡风险较高的临床因素包括心脏骤停、抗凝血酶治疗、心源性休克和年龄>70 岁。
在这项对 ACS 患者的观察性研究中，ACS 的证据基础药物治疗使用率相当高，但仍有 39%的 STEMI 患者未接受再灌注治疗。这些发现表明，在发展中国家，进一步降低 ACS 患者长期缺血事件风险的机会仍然存在。
