Cardiology Letters 2017, 26(3):125-137

Management of patients with Acute Coronary Syndromes in Slovakia in 2015. Current analysis of the SLOVAKS registry.

Studenčan M¹, Hricák V², Kovář F³, Kurray P⁴, Kamenský G⁵, Šimková I², Hatala R²

¹ Kardiocentrum FNsP J. A. Reimana, Prešov

² Klinika kardiológie a angiológie NÚSCH, a. s. Bratislava

³ Prvej interná klinika MFN, Martin

⁴ Kardiocentrum Nitra

⁵ V. interná klinika UN v Bratislave, Slovenská republika

In 2015 a periodical snapshot of the SLOVAKS registry, related to the management of patients with acute coronary syndromes, was made.

Results: 1704 patients with ACS were analysed. STEMI represented 32.5% of cases, UA 29.5%, NSTEMI 36.4% and 1.6% had LBBB on ECG. In category of ACS without ST elevation 75.8% belonged to the middle risk or high risk group, according to the TIMI risk score. Only 64.6% of patients in this category underwent invasive management. In STEMI patients 73% of them underwent primary reperfusion treatment (pPCI 70.7%, fibrinolysis 2.34%). The median total ischaemic time was 230,5 minutes. 36.6% of all pPCIs were performed outside the recommended maximum time interval (i.e. 120 min of ECG diagnosis) and 65% outside the recommended optimal time interval (i.e. 90 min of ECG diagnosis). The main reasons for avoidable time delay were hesitation of patients (median of symptoms to ECG interval 110 min) and transportation of patients, since 35% of STEMI patients were admitted to pPCI centers via secondary transportation. Hospital mortality of STEMI patients was 5.77%.

Conclusion: Despite a few positive trends in ACS management in Slovakia (the high concentration of EMS ambulances, unlimited availability of modern drugs, availability of invasive management on 24/7 basis) there remain some problems in ACS management we can identify. In the UA/NSTEMI category there is suboptimal ratio of invasively treated patients, and the optimal timing of catheterisation is underappreciated. At the same time, the proportion of up-to-date antithrombotic regimes is not sufficient in this ACS category. In the STEMI category there is an unacceptable time delay due to hesitation of patients, and also owing to the health care system, especially because of unecessary secondary transportation. A significant proportion of STEMI patients fulfilled the criteria for prehospital fibrinolysis administration and pharmacoinvasive strategy. In fact we have noticed an unreasonable disappearance of fibrinolysis.

Keywords: acute coronary syndrome; STEMI; UA; NSTEMI management; time intervals; primary PCI; risk stratification

Published: March 1, 2017  Show citation