open access

Vol 69, No 11 (2011)
Original articles
Published online: 2011-11-17
Submitted: 2012-12-28
Get Citation

What has changed in the treatment of ST−segment elevation myocardial infarction in Poland in 2003–2009? Data from the Polish Registry of Acute Coronary Syndromes (PL−ACS)

Lech Poloński, Mariusz Gąsior, Marek Gierlotka, Krzysztof Wilczek, Zbigniew Kalarus, Jacek Dubiel, Witold Rużyłło, Waldemar Banasiak, Grzegorz Opolski, Marian Zembala
Kardiol Pol 2011;69(11):1109-1118.

open access

Vol 69, No 11 (2011)
Original articles
Published online: 2011-11-17
Submitted: 2012-12-28

Abstract

Background: A substantial progress has been made in Poland in the field of acute coronary syndromes (ACS) management over the last 10 years.
Aim: To present the data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) collected between 2003 and 2009. Changes in treatment strategies and outcomes in ST-segment myocardial infarction (STEMI) were analysed.
Methods: We analysed patients enrolled to the PL-ACS Registry — a nationwide multicenter, prospective observational study of consecutive patients hospitalised with ACS in Poland.
Results: Overall, 284,162 patients with ACS were enrolled in 512 centres including 88 invasive cardiology centres. The STEMI was diagnosed in 35–36% of these patients in 2003–2005, and this proportion remained stable at 30% to 32% in 2006–2009. The mean age of STEMI patients increased from 62.5 years in 2003 to 64.5 in 2009. During this period, women represented 32.7% to 34.6% of the STEMI patients. Proportion of patients presenting with pulmonary oedema or cardiogenic shock decreased with time, from 15.5% in 2003 to 8% in 2009. Delays to reperfusion tended to reduce over time: pain-to- -admission time was 240 min in 2005 and 229 min in 2009 and door-to-balloon time was 32 and 25 min in 2005 and 2009, respectively, with the delay being longer in the elderly population. The proportion of patients undergoing coronary angiography showed a constant increase, from 55% in 2003 to 84% in 2009. Percutaneous coronary intervention was performed in 51% and 78% of patients in 2003 and 2009, respectively. At the same time, the proportion of patients undergoing thrombolysis declined from 14% to 1%. Aspirin, beta-blocker, statin and ACE inhibitor use was constantly high, while nitrate use declined from 82% to 15%. The proportion of patients receiving clopidogrel increased from 40% to 97% over the analysed period. Significant reductions in mortality rates were observed: in-hospital mortality decreased from 11.9% to 6.4%; 30-day mortality from 13.5% to 9.6%; and 12-month mortality from 19.8% to 15.4% in 2003 and 2009, respectively. Invasive treatment strategy was associated with better in-hospital and long-term patient survival.
Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock.
Kardiol Pol 2011; 69, 11: 1109–1118

Abstract

Background: A substantial progress has been made in Poland in the field of acute coronary syndromes (ACS) management over the last 10 years.
Aim: To present the data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) collected between 2003 and 2009. Changes in treatment strategies and outcomes in ST-segment myocardial infarction (STEMI) were analysed.
Methods: We analysed patients enrolled to the PL-ACS Registry — a nationwide multicenter, prospective observational study of consecutive patients hospitalised with ACS in Poland.
Results: Overall, 284,162 patients with ACS were enrolled in 512 centres including 88 invasive cardiology centres. The STEMI was diagnosed in 35–36% of these patients in 2003–2005, and this proportion remained stable at 30% to 32% in 2006–2009. The mean age of STEMI patients increased from 62.5 years in 2003 to 64.5 in 2009. During this period, women represented 32.7% to 34.6% of the STEMI patients. Proportion of patients presenting with pulmonary oedema or cardiogenic shock decreased with time, from 15.5% in 2003 to 8% in 2009. Delays to reperfusion tended to reduce over time: pain-to- -admission time was 240 min in 2005 and 229 min in 2009 and door-to-balloon time was 32 and 25 min in 2005 and 2009, respectively, with the delay being longer in the elderly population. The proportion of patients undergoing coronary angiography showed a constant increase, from 55% in 2003 to 84% in 2009. Percutaneous coronary intervention was performed in 51% and 78% of patients in 2003 and 2009, respectively. At the same time, the proportion of patients undergoing thrombolysis declined from 14% to 1%. Aspirin, beta-blocker, statin and ACE inhibitor use was constantly high, while nitrate use declined from 82% to 15%. The proportion of patients receiving clopidogrel increased from 40% to 97% over the analysed period. Significant reductions in mortality rates were observed: in-hospital mortality decreased from 11.9% to 6.4%; 30-day mortality from 13.5% to 9.6%; and 12-month mortality from 19.8% to 15.4% in 2003 and 2009, respectively. Invasive treatment strategy was associated with better in-hospital and long-term patient survival.
Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock.
Kardiol Pol 2011; 69, 11: 1109–1118
Get Citation

Keywords

ST-segment elevation myocardial infarction; treatment strategy; primary percutaneous coronary intervention; temporal trends; 12-month mortality

About this article
Title

What has changed in the treatment of ST−segment elevation myocardial infarction in Poland in 2003–2009? Data from the Polish Registry of Acute Coronary Syndromes (PL−ACS)

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 11 (2011)

Pages

1109-1118

Published online

2011-11-17

Bibliographic record

Kardiol Pol 2011;69(11):1109-1118.

Keywords

ST-segment elevation myocardial infarction
treatment strategy
primary percutaneous coronary intervention
temporal trends
12-month mortality

Authors

Lech Poloński
Mariusz Gąsior
Marek Gierlotka
Krzysztof Wilczek
Zbigniew Kalarus
Jacek Dubiel
Witold Rużyłło
Waldemar Banasiak
Grzegorz Opolski
Marian Zembala

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl