The MASCARA Registry Reveals the True Nature of Acute Coronary Syndromes Treatment in Spain

Abstract

Acute coronary syndromes (ACS) are the most common clinical manifestation of coronary heart disease. Despite great progress in initial risk stratification, the incorporation of powerful antithrombotic agents and platelet aggregation inhibitors, and the application of more invasive strategies, the prognosis of these patients continues to be significantly poor. The clinical practice guidelines recommend initial invasive strategies as first-line treatment in a large proportion of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) and in patients with persistent ST-segment elevation acute coronary syndrome (STEACS). In high-risk patients with NSTEACS, coronary angiography followed by revascularization significantly reduces ischemic events in the long-term compared to a more conservative initial strategy (coronary angiography and revascularization only in the case of spontaneous or induced ischemia). 1-3 In the patients with STEACS, primary percutaneous coronary intervention (PCI) offers greater benefits than thrombolysis, and is the recommended reperfusion method whenever it is done within the recommended time-frame. 4,5 The MASCARA registry was a prospective study, with a randomized selection of centers and consecutive inclusion of patients, and was designed to determine the clinical profile, management and effects of intervention strategies in patients with ACS. 6 It was conducted in 2004-2005, and after the application of comprehensive quality controls, it provided data on the 7251 patients included in the study (56% with NSTEACS, 38% with STEACS, and 6% with nonclassifiable ACS) from