Erlikh A D, Gratsiansky On Behalf Of Record-Participants N A
Research Institute for Physicochemical Medicine, Moscow, Russia.
Kardiologiia. 2016 Apr;56(4):16-24.
Acute Coronary Syndrome (ACS) Registries RECORD 1-2 (2007-2001) gave valuable information on management of ACS patients in Russia. RECORD-3 was carried out in March-April, 2015. Here we present characteristics of included patients (pts) and data on their treatment during initial hospitalization.
RECORD-3 recruited pts with suspected ACS consecutively hospitalized in participating hospitals (n=47, 55% "invasive") during 1 month.
Number of included pts was 2370 (39% women, mean age 64.6 years), 72% were admitted to invasive hospitals, 37% had ST-elevation ACS (STEACS). Median "onset of symptoms - first medical contact" time was 3.4 (1.0-16.8) hours, "first medical contact - hospital admission" time - 1.5 (1.0-3.1) hours. Cardiac troponin was determined in 76% of pts. Coronary angiography was carried out in 70 and 46% of pts with STE and non-STE ACS, respectively. (16% of all patients hospitalized in "noninvasive" cetnters were transferred for angiography to invasive ones). Primary percutaneous coronary intervention (PCI) was performed in 39% of patients with STEACS (in 65% of them with "door to pPCI" time less or equal 90 min). Thrombolytic therapy (TLT) was administered to 32% of pts (in half of them prehospitally). Overall reperfusion therapy received 68% of pts. Among non-STEACS pts rate of PCI was 20% (1/3 of procedures within 2, 1/3 - >2-24hours). Inhospital antiplatelet therapy (APT) included aspirin (88%), clopidogrel (71%), ticagrelor (14%); 86% of pts received dual APT. Other medications were: unfractionated heparin (UFH, 47% [81% subcutaneously]), enoxaparin (13%), fondaparinux (10%), angiotensin converting enzyme inhibitors/sartans (81%), -adrenoblockers (84%), statins (87%). Mortality during hospitalization (median 10 days) was 10% in STE, and 5% in non-STE ACS.
Inhospital management of RECORD-3 population was characterized by relatively low rates of pPCI, reperfusion therapy in STEACS, urgent PCI in non-STEACS. Preponderance of UFG including its subcutaneous use is of note. Use of other standard therapies appears satisfactory.
急性冠状动脉综合征（ACS）注册研究记录1 - 2（2007 - 2001年）提供了俄罗斯ACS患者管理的宝贵信息。记录3于2015年3月至4月进行。在此，我们呈现纳入患者（pts）的特征及其首次住院期间的治疗数据。
记录3连续招募了在参与医院住院（n = 47，55%“侵入性”）的疑似ACS患者，为期1个月。
纳入患者数量为2370例（39%为女性，平均年龄64.6岁），72%入住侵入性医院，37%患有ST段抬高型ACS（STEACS）。“症状发作 - 首次医疗接触”时间中位数为3.4（1.0 - 16.8）小时，“首次医疗接触 - 入院”时间为1.5（1.0 - 3.1）小时。76%的患者检测了心肌肌钙蛋白。STEACS和非STEACS患者分别有70%和46%进行了冠状动脉造影。（在“非侵入性”中心住院的所有患者中有16%被转至侵入性中心进行造影）。39%的STEACS患者接受了直接经皮冠状动脉介入治疗（pPCI）（其中65%的患者“门到pPCI”时间小于或等于90分钟）。32%的患者接受了溶栓治疗（TLT）（其中一半在院前）。总体而言，68%的患者接受了再灌注治疗。在非STEACS患者中，PCI率为20%（三分之一的手术在2小时内，三分之一在>2 - 24小时内）。住院期间抗血小板治疗（APT）包括阿司匹林（88%）、氯吡格雷（71%）、替格瑞洛（14%）；86%的患者接受了双重APT。其他药物包括：普通肝素（UFH，47%[81%皮下注射]）、依诺肝素（13%）、磺达肝癸钠（10%）、血管紧张素转换酶抑制剂/沙坦类药物（81%）、β受体阻滞剂（84%）、他汀类药物（87%）。住院期间（中位数10天）STEACS患者死亡率为10%，非STEACS患者死亡率为5%。
记录3人群的住院管理特点是pPCI率相对较低、STEACS患者再灌注治疗率低、非STEACS患者紧急PCI率低。值得注意的是普通肝素使用占优势，包括皮下使用。其他标准治疗的使用情况似乎令人满意。
