Calabrò Paolo, Gragnano Felice, Di Maio Marco, Patti Giuseppe, Antonucci Emilia, Cirillo Plinio, Gresele Paolo, Palareti Gualtiero, Pengo Vittorio, Pignatelli Pasquale, Pennacchi Mauro, Granatelli Antonino, De Servi Stefano, De Luca Leonardo, Marcucci Rossella
1 Division of Clinical Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy; Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
2 Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Angiology. 2018 Oct;69(9):795-802. doi: 10.1177/0003319718760917. Epub 2018 Mar 15.
The epidemiology and management of patients with acute coronary syndromes (ACSs) have evolved. We aimed to describe recent demographics and therapeutic changes in the Italian ACS population. We analyzed data from 2 multicenter consecutive Italian registries (the EYESHOT [EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalised in iTalian cardiac care units] and START-ANTIPLATELET registries) enrolling patients with ACS between December 2013 and June 2016. An overall population of 3756 patients with ACS was enrolled: 2585 in the EYESHOT and 1171 in the START-ANTIPLATELET. Compared with the EYESHOT, patients in the START-ANTIPLATELET registry presented more frequently with ST-segment elevation myocardial infarction and were more often smokers and dyslipidemic (all P < .001) and had atrial fibrillation ( P = .018) but were less frequently aged ≥75 years and with a history of major bleeding (all P < .001). Analysis of treatment strategy showed a significant increase in the use of percutaneous coronary intervention, drug-eluting stents, dual antiplatelet therapy, and ticagrelor in the START-ANTIPLATELET (all P < .001), with a substantial decline in the proportion of patients conservatively managed and on clopidogrel at discharge ( P < .001). A lower rate of in-hospital events was recorded in the START-ANTIPLATELET compared with the EYESHOT. The START-ANTIPLATELET and EYESHOT registries provide consecutive snapshots in the contemporary management of patients with ACS in Italy, showing important changes in both demographic characteristics and treatment strategies.
急性冠状动脉综合征（ACS）患者的流行病学及管理情况已有所演变。我们旨在描述意大利ACS患者群体近期的人口统计学特征及治疗变化。我们分析了来自两个意大利多中心连续注册研究（EYESHOT[意大利心脏监护病房收治的急性冠状动脉综合征患者使用的抗血栓治疗]和START - 抗血小板注册研究）的数据，这些研究纳入了2013年12月至2016年6月期间的ACS患者。共纳入3756例ACS患者：EYESHOT研究中纳入2585例，START - 抗血小板研究中纳入1171例。与EYESHOT研究相比，START - 抗血小板注册研究中的患者更常表现为ST段抬高型心肌梗死，吸烟和血脂异常的比例更高（所有P <.001），且患有心房颤动（P =.018），但年龄≥75岁及有大出血病史的患者比例较低（所有P <.001）。治疗策略分析显示，START - 抗血小板研究中经皮冠状动脉介入治疗、药物洗脱支架、双联抗血小板治疗及替格瑞洛的使用显著增加（所有P <.001），出院时接受保守治疗及使用氯吡格雷的患者比例大幅下降（P <.001）。与EYESHOT研究相比，START - 抗血小板研究记录的院内事件发生率较低。START - 抗血小板研究和EYESHOT研究提供了意大利当代ACS患者管理的连续情况，显示出人口统计学特征和治疗策略均有重要变化。
