The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004

TLDR

The study examined the management of acute coronary syndromes in Europe and the Mediterranean basin and compared guideline adherence with the first Euro Heart Survey on ACS conducted four years earlier. A prospective survey in 2004 collected data on the characteristics, treatment, and outcomes of 6,385 ACS patients from 190 medical centres across 32 countries. Compared with the 2000 survey, baseline characteristics were similar but the 2004 survey showed markedly higher use of guideline‑recommended medications, coronary interventions, and primary reperfusion—especially a shift from fibrinolysis to primary PCI, with PCI rates rising from 37 % to 59 %—leading to overall improved adherence to treatment guidelines.

Abstract

Aims Our study aimed to examine the management of acute coronary syndromes (ACS) in Europe and the Mediterranean basin, and to compare adherence to guidelines with that reported in the first Euro Heart Survey on ACS (EHS–ACS-I), 4 years earlier. Methods and results In a prospective survey conducted in 2004 (EHS–ACS-II), data describing the characteristics, treatment, and outcome of 6385 patients diagnosed with ACS in 190 medical centres in 32 countries were collected. ACS with ST-elevation was the initial diagnosis in 47% of patients, no ST-elevation in 48%, and undetermined electrocardiographic pattern in 5% of patients. Comparison of data collected in 2000 and 2004 showed similar baseline characteristics, but greater use of recommended medications and coronary interventions in EHS–ACS-II. Among patients with ST-elevation, the use of primary reperfusion increased slightly (from 56 to 64%), with a significant shift from fibrinolytic therapy to primary percutaneous coronary intervention (PPCI). The use of PPCI rose from 37 to 59% among those undergoing primary reperfusion therapy. Analysis of data in 34 centres that participated in both surveys showed even greater improvement with respect to the use of recommended medical therapy, interventions, and outcome. Conclusion Data from EHS–ACS-II suggest an increase in adherence to guidelines for treatment of ACS in comparison with EHS–ACS-I.