The use of revascularization strategies in patients with acute coronary syndromes admitted to hospitals without catheterization facilities: Results from the ALERT-CZ registry

Abstract

AimPercutaneous coronary intervention (PCI) became the standard of care for patients (pts) with acute coronary syndromes (ACS). Czech Republic is among European countries with well developed networks of PCI and non-PCI hospitals. Ample data about PCI-treated pts is available from many registries. Much less is known about treatments and outcomes of ACS pts admitted to hospitals without cath-lab. ALERT-CZ registry was designed specifically to analyze these pts presenting to local non-PCI hospitals. The aim was to see, whether the ESC guidelines are implemented in these local, small hospitals. Methods and resultsA total of 6265 pts with first hospital admission for ACS has been enrolled in 32 Czech community hospitals without cath-lab during a 3-year period (7/2008–6/2011). The mean age was 69.7±12.3 years, 39.5% were females, 35.4% had known diabetes mellitus, 76.0% hypertension, 28.3% previous myocardial infarction and 12.0% previous stroke. Twenty-five percent pts had signs of acute heart failure (Killip II in 19.0%, Killip III in 4.8% and Killip IV in 1.1%). The discharge diagnosis was ST-elevation myocardial infarction (STEMI) in 26.1%, non-STEMI in 53.1% and unstable angina pectoris (UAP) in 20.9%.Emergent interhospital transport to coronary angiography (CAG) and PCI within <12h from symptom onset was indicated in 73.4% of STEMI pts, elective CAG was indicated in 15.9% of STEMI, CAG was not indicated in 9.9% of STEMI and 0.9% STEMI pts refused CAG. Among non-STE ACS pts CAG was performed within <24h in 16.2%, between 24–72h in 18.2%, later in 38.1%, not indicated in 22.7%, refused by pts in 4.8%. The median stay in the PCI center was 2.0 days and only 37% pts returned after CAG (±PCI) to the referring community hospital, the rest was discharged from PCI center directly to home.Among STEMI pts the median time intervals were: pain—first medical contact (FMC) 120min, FMC—community hospital door 30min, door-in–door-out for emergency transfer 23min. Thrombolysis was used in 0.4% of STEMI—in rare situations when immediate transfer was logistically not possible.PCI was performed in 41.6% pts overall (65.9% STEMI, 35.8% non-STEMI and 26.4% UAP). CABG was performed in 2.9% pts overall (2.1%, 3.1% and 3.6% per diagnosis). Detailed pharmacotherapy data as well as indirect comparison with a separate PCI centers registry is beyond the space frame of this abstract and will be presented.The overall in-hospital mortality was 7.2%. Mortality per final diagnosis was 9.5% (STEMI), 8.7% (non-STEMI) and 0.5% (UAP). Mortality per age group was 16.2% (>80 years), 8.0% (70–80 years) and 2.4% (<70 years). ConclusionPatients presenting to non-PCI hospitals undergo revascularization procedures less frequently than those directly admitted to PCI centers. This may be related to baseline differences. The outcomes are influenced by these facts.