Aim: Amongst cardiovascular diseases (CVD), acute coronary syndrome (ACS) is an important cause of cardiovascular mortality. The aim of the study was to examine ACS in Zagreb, to determine how it is treated, and to assess the extent to which new guidelines have been implemented in daily practice. During the last decades, great improvements have been made in the prevention and management of ACS. We wished to ascertain how these improvements have been implemented in our hospitals in the year 2003.
Methods: We carried out a retrospective study including patients in the City of Zagreb that had been discharged from the hospital with the diagnosis of ACS. The community-based Registry of Acute Coronary Syndrome for the City of Zagreb for the year 2003 served as the source of data. Records on 1,733 ACS patients were analyzed. In 1,349 hospitalized patients, the following parameters were investigated: length of hospital stay; time from onset of symptoms to arrival in hospital; rate of angiography and reperfusion and medical therapy after discharge.
Results: Study results showed that 1,105 (64%) patients were discharged from hospital, 244 (14%) died in hospital, and 384 (22%) died outside hospital. There were 1,136 (84%) patients with AMI, 638 (56%) with ST segment elevation MI, 391 (34%) with non-ST segment elevation MI and 107 (10%) of patients with possible MI and MI with undetermined ECG. Patient records revealed that 688 (51%) stayed in hospital between 8 and 14 days. The time from symptom onset to hospital arrival was less than 6 hours in 566 patients, 349 (44%) men and 217 (39%) women; 6 to 12 hours in 157 patients, 79 (10%) men and 78 (14%) women; and over 12 hours in 410 patients, 238 (30%) men and 172 (31%) women. The time of symptom onset was unknown in 216 patients, 127 (16%) men and 89 (16%) women. Angiography and reperfusion therapy were performed in 557 (41%) patients, 373 (47%) men, and 184 (33%) women; PCI/PCI + stent in 33% of men with ST or non-ST segment elevation, and 25% of women with ST segment elevation and 19% of women with non-ST segment elevation. Fibrinolytic therapy was performed in 86 patients, 53 (7%) men and 30 (5%) women. Amongst ACS patients (N=966), 85% took aspirin, 70% beta-blockers, 69% angiotensin converting enzyme inhibitors and 63% statins.
Discussion and conclusion: Compared to other studies, non-ST segment elevation MI and unstable angina seemed to be less often diagnosed. Patients arrived in hospital rather late after symptom onset, and this was probably one of the reasons that reperfusion therapy could not be sufficiently applied. We also noted that physicians did not always follow the generally accepted guidelines to enable a better outcome by use of preventative measures and higher rate of effective therapy. There are important lessons to be learnt from this study for both patients and physicians.