Real-world treatment patterns of patients with acute coronary syndrome based on 15-year data

BACKGROUND: About half a million cases of acute coronary syndrome (ACS) are diagnosed in Russia every year. However, despite optimized treatment of patients with ACS, mortality remains high, which dictates the need to analyze the effectiveness of therapeutic measures.

AIM: To evaluate the real-world clinical features, treatment approaches, and outcomes in patients with ACS based on data from the long-term registry of the Regional Vascular Center.

MATERIALS AND METHODS: The study included consecutive 8 347 patients admitted to the Regional Vascular Center of the Republic of Karelia for ACS in 2008–2023. The clinical features, drug therapy, reperfusion interventions, complication rate, outcomes, and mortality were evaluated. The effectiveness of therapeutic measures in patients with ACS was analyzed using the obtained data and a 15-year real-world register.

RESULTS: The study included 8 247 patients, and there were more men (4 989 patients; 60.5%); 1 502 (18%) patients had a history of myocardial infarction; 4 741 (56.8%) were diagnosed with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In the study group, 4 481 (53.7%) emergency percutaneous coronary interventions (PCI) were performed for ACS. For ST-segment elevation acute coronary syndrome (STEACS), 2 928 (81.2%) patients had PCI, and 228 (7.8%) patients had thrombolytic therapy followed by PCI. Thrombolysis was performed in 113 (43%) and 150 (57%) patients before and after hospitalization, respectively. Efficacy criteria were determined in 57 (50.4%) and 107 (71.3%) patients with pre- and in-hospital interventions, respectively. Analysis of drug therapy for ACS showed that aspirin was prescribed in 8 255 (98.9%), β-blockers in 7 671 (91.9%), and statins in 8 138 (97.5%) cases. Life-threatening complications occurred in 1 out of 3 patients with STEACS and 1 out of 7 patients with NSTE-ACS. Cardiac arrest (p <0.0001), myocardial rupture (p=0.001), arrhythmias (p <0.0001), and cardiogenic shock (p <0.0001) were significantly more common in patients with STEACS, and pulmonary edema (p=0.005) was significantly more common in patients with NSTE-ACS. Hospital mortality was significantly higher in STEACS patients (p <0.0001).

The most common ACS outcome was myocardial infarction (2 955 (35.4%) patients with Q-wave MI and 2 045 (24.5%) patients with non-Q-wave MI). Unstable angina was diagnosed in 1 569 (18.8%) patients.

CONCLUSION: Fifteen-year register data showed a high percentage of reperfusion interventions for ACS and prescription of drugs that improve the prognosis. A high percentage of life-threatening complications was noted, especially in STEACS; however, hospital mortality is low if proper treatment is provided.