Wang Ricardo, Neuenschwander Fernando Carvalho, Lima Filho Augusto, Moreira Celsa Maria, Santos Elizabete Silva dos, Reis Helder Jose Lima, Romano Edson Renato, Mattos Luiz Alberto Piva e, Berwanger Otávio, Andrade Jadelson Pinheiro de
Hospital Vera Cruz, Belo Horizonte, MG, Brasil.
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil.
Arq Bras Cardiol. 2014 Apr;102(4):319-26. doi: 10.5935/abc.20140033. Epub 2014 Feb 17.
The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice.
To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil.
This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated.
This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times.
This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended.
指南中的建议基于证据；然而，建议与临床实践之间存在差距。
描述巴西急性冠状动脉综合征患者循证治疗的处方情况。
本研究对ACCEPT注册研究进行了子分析，评估了流行病学数据以及阿司匹林、P2Y12抑制剂、抗血栓药物、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（IAT1RB）和他汀类药物的处方率。此外，还评估了ST段抬高型心肌梗死患者心肌再灌注的质量。
本研究评估了2453例患者。阿司匹林、P2Y12抑制剂、抗血栓药物、β受体阻滞剂、血管紧张素转换酶抑制剂/IAT1RB和他汀类药物的处方率如下：24小时内分别为97.6%、89.5%、89.1%、80.2%、67.9%和90.6%；六个月时分别为89.3%、53.6%、0%、74.4%、57.6%和85.4%。对于ST段抬高型心肌梗死，分别只有35.9%和25.3%的患者在推荐时间内接受了直接血管成形术和溶栓治疗。
该注册研究显示抗血小板药物、抗血栓药物和他汀类药物的初始处方率较高，而β受体阻滞剂和血管紧张素转换酶抑制剂/IAT1RB的处方率较低。无论药物类别如何，所有药物的使用在六个月时均有所下降。大多数ST段抬高型心肌梗死患者未在推荐时间内接受心肌再灌注治疗。
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