011: The major part of one-year prognosis of acute coronary syndromes is associated with the severity of the initial clinical presentation - Results from the French MONICA registries

Abstract

Death rate of acute coronary syndromes has decreased for more than 50 years. Out-of-hospital mortality remains high despite improvements in acute coronary syndrome's care. To evaluate the importance of out-of-hospital mortality and the main determinants of in-hospital and one-year mortality in France. Analyses were based on data from the French MONICA population-based registry including exhaustively all acute coronary syndromes occurring in people aged 35–74 during the year 2006 in 3 geographic areas. First we evaluated out-of-hospital mortality. Then analyses were performed through Cox models on incident ACS reaching the hospital alive in order to determine main factors explaining the one-year mortality. Number of attributable deaths was assessed for variables of interest. After a one-year follow-up, case-fatality was 29.3% for incident events (n=2547) with 70.3% of out-of-hospital deaths and 21.1% occurring in the 28 days following the event. The number of attributable deaths related to 3 situations with a strong impact identified from multivariate analyses (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (59% of deaths occurring after reaching the hospital) during the one-year follow-up. These sub-groups were corresponding to patients with an important initial state of severity and not benefiting from traditionally recommended treatments. The major part of deaths after ACS occurs in the out-of-hospital phase. Moreover, the major part of one-year mortality is associated with a very poor prognosis before medicalization. This underlines the importance of cardiovascular prevention, population education and better out-of-hospital emergency management.