Cardiology Letters 2014, 23(2):115-125

Current trends in management of NSTE-ACS patients in the Slovak Republic. Analysis of the SLOVAKS-2 registry from 2011.

Kovář F¹, Studenčan M², Hricák V³, Kurray P⁴, Alberty R⁵, Gonçalvesová E³, Kamenský G⁶

¹ 1I. interná klinika Univerzitnej nemocnice v Martine

² Kardiocentrum FNsP J. A. Reimana v Prešove

³ Národný ústav srdcových a cievnych chorôb a.s. v Bratislave

⁴ Kardiocentrum Nitra, s.r.o. v Nitre

⁵ Univerzita Mateja Bela v Banskej Bystrici

⁶ V. interná klinika Univerzitnej nemocnice v Bratislave, Slovenská republika

Introduction: Acute coronary syndrome without ST segment elevation (NSTE-ACS) is a prognostically serious disease with potentially high lethality. The Slovak registry of acute coronary syndromes - SLOVAKSserves to collect data on NSTE-ACS patients in Slovakia.

Objective: To analyze and evaluate data on the management of NSTE-ACS in Slovakia, and assess implementation of the up-to-date guidelines in real clinical practice.

Methods: Data for the analysis were collected during two months (August and September) 2011. Electronic reports of hospitalizations of patients with NSTE-ACS were sent from 68 departments (i.e. 88% of total) in Slovakia. Selected history data, risk stratification of ACS, a comprehensive pharmacological treatment, indication for invasive diagnostics (SKG) and coronary revascularization (both PCI and CABG) data were provided. The analysis was carried out in the entire group of patients and in the sub-groups by gender, increased troponin, and diabetes mellitus. Mortality was assessed during 30 days, 6, and 12 months.

Results: 1082 reports were evaluated for hospitalization of patients with NSTE-ACS, 682 men (mean age 64.6 ± 11.3 y.) and 400 women (mean age 71.3 ± 10.5 y.). 520 patients were hospitalized for unstable angina pectoris (UA) and 562 hospitalizations were for myocardial infarction without ST elevation (NSTEMI). Among patients with UA and NSTEMI a high incidence of hypertension (92.7% and 88.4%) and diabetes mellitus (33.7% resp. 40.7%) was observed. A high proportion of pts. with UA and NSTEMI (over 80-90%) was treated with dual antiplatelet therapy, beta-blockers, ACE inbibitors/ARBs and statins. An increased number of pts. with UA and NSTEMI underwent coronary angiography (68.3% and 62.8%), PCI (44.2% resp. 35.9%) and CABG (10.6% resp. 13.7%). The mortality rate in patients with UA was lower compared to NSTEMI in both patients with diabetes (30 day: 1.2% vs 7.0%, p = 0.011 and 6 months: 8.2% vs 14.5%, p = 0.052) and without diabetes (30 day: 0.9% vs 8.3%, p = 0.000 and 6 months: 3.3% vs 15.1%, p = 0.000). One-year mortality rate in NSTEMI showed a nearly 3.5-fold increased compared with UA (odds ratio, 95% CI): 3.384 (2.253 to 5.082), p < 0.001.

Conclusion: The results of SLOVAKS-2 registry analysis confirmed the satisfactory implementation of the recommendations for the pharmacological treatment of NSTE-ACS in Slovakia. Compared to the years 2007-2008 there has been a noticeable increase in invasive exams and subsequently revascularized patients. In the future it will be necessary to pay particular attention to high risk groups with NSTE-ACS.

Keywords: registry of acute coronary syndromes; SLOVAKS; UA, NSTEMI; medical therapy; invasive diagnosis; mortality

Published: February 1, 2014  Show citation