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Management of acute coronary syndrome in South Africa: insights from the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) registry.
Cardiovasc J Afr. 2012 Aug; 23(7):365-70.CJ

Abstract

BACKGROUND

The burden of cardiovascular diseases is predicted to escalate in developing countries. While many studies have reported the descriptive epidemiology, practice patterns and outcomes of patients hospitalised with acute coronary syndromes (ACS), these have largely been confined to the developed nations.

METHODS

In this prospective, observational registry, 12 068 adults hospitalised with a diagnosis of ACS were enrolled between January 2007 and January 2008 at 134 sites in 19 countries in Africa, Latin America and the Middle East. Data on patient characteristics, treatment and outcomes were collected.

RESULTS

Of the 642 patients from South Africa in the registry, 615 had a confirmed ACS diagnosis and form the basis of this report; 41% had a discharge diagnosis of ST-segment elevation myocardial infarction (STEMI) and 59% a diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS), including 32% with non-ST-segment elevation myocardial infarction (NSTEMI) and 27% with unstable angina (UA). During hospitalisation, most patients received aspirin (94%) and a lipid-lowering medication (91%); 69% received a beta-blocker, and 66% an ACE inhibitor/angiotensin receptor blocker. Thrombolytic therapy was used in only 18% of subjects (36% of STEMI patients and 5.5% of NSTE-ACS patients). Angiography was undertaken in 93% of patients (61.3% on the first day), of whom 53% had a percutaneous coronary intervention (PCI) and 14% were referred for coronary artery bypass surgery. Drug-eluting stents were used in 57.9% of cases. Clopidogrel was prescribed at discharge from hospital in 62.2% of patients. All-cause death at 12 months was 5.7%, and was higher in patients with STEMI versus non-ST-elevation ACS (6.7 vs 5.0%, p < 0.0001). Clinical factors associated with higher risk of death at 12 months included age ≥ 70 years, presence of diabetes mellitus on admission, and a history of stroke/transient ischaemic attack (TIA).

CONCLUSIONS

In this observational study of ACS patients, the use of evidence-based pharmacological therapies for ACS was quite high. Interventional rates were high compared to international standards, and in particular the use of drug-eluting stents, yet the clinical outcomes (mortality, re-admission rates and severe bleeding episodes at one year) were favourable, with low rates compared with other studies.

Authors+Show Affiliations

Milpark Hospital, Johannesburg, South Africa. cscham@global.co.zaNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22447241

Citation

Schamroth, Colin, and ACCESS South Africa investigators. "Management of Acute Coronary Syndrome in South Africa: Insights From the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) Registry." Cardiovascular Journal of Africa, vol. 23, no. 7, 2012, pp. 365-70.
Schamroth C, ACCESS South Africa investigators. Management of acute coronary syndrome in South Africa: insights from the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) registry. Cardiovasc J Afr. 2012;23(7):365-70.
Schamroth, C. (2012). Management of acute coronary syndrome in South Africa: insights from the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) registry. Cardiovascular Journal of Africa, 23(7), 365-70. https://doi.org/10.5830/CVJA-2012-017
Schamroth C, ACCESS South Africa investigators. Management of Acute Coronary Syndrome in South Africa: Insights From the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) Registry. Cardiovasc J Afr. 2012;23(7):365-70. PubMed PMID: 22447241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of acute coronary syndrome in South Africa: insights from the ACCESS (Acute Coronary Events - a Multinational Survey of Current Management Strategies) registry. AU - Schamroth,Colin, AU - ,, Y1 - 2012/03/13/ PY - 2012/01/20/received PY - 2012/03/01/accepted PY - 2012/3/27/entrez PY - 2012/3/27/pubmed PY - 2013/1/18/medline SP - 365 EP - 70 JF - Cardiovascular journal of Africa JO - Cardiovasc J Afr VL - 23 IS - 7 N2 - BACKGROUND: The burden of cardiovascular diseases is predicted to escalate in developing countries. While many studies have reported the descriptive epidemiology, practice patterns and outcomes of patients hospitalised with acute coronary syndromes (ACS), these have largely been confined to the developed nations. METHODS: In this prospective, observational registry, 12 068 adults hospitalised with a diagnosis of ACS were enrolled between January 2007 and January 2008 at 134 sites in 19 countries in Africa, Latin America and the Middle East. Data on patient characteristics, treatment and outcomes were collected. RESULTS: Of the 642 patients from South Africa in the registry, 615 had a confirmed ACS diagnosis and form the basis of this report; 41% had a discharge diagnosis of ST-segment elevation myocardial infarction (STEMI) and 59% a diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS), including 32% with non-ST-segment elevation myocardial infarction (NSTEMI) and 27% with unstable angina (UA). During hospitalisation, most patients received aspirin (94%) and a lipid-lowering medication (91%); 69% received a beta-blocker, and 66% an ACE inhibitor/angiotensin receptor blocker. Thrombolytic therapy was used in only 18% of subjects (36% of STEMI patients and 5.5% of NSTE-ACS patients). Angiography was undertaken in 93% of patients (61.3% on the first day), of whom 53% had a percutaneous coronary intervention (PCI) and 14% were referred for coronary artery bypass surgery. Drug-eluting stents were used in 57.9% of cases. Clopidogrel was prescribed at discharge from hospital in 62.2% of patients. All-cause death at 12 months was 5.7%, and was higher in patients with STEMI versus non-ST-elevation ACS (6.7 vs 5.0%, p < 0.0001). Clinical factors associated with higher risk of death at 12 months included age ≥ 70 years, presence of diabetes mellitus on admission, and a history of stroke/transient ischaemic attack (TIA). CONCLUSIONS: In this observational study of ACS patients, the use of evidence-based pharmacological therapies for ACS was quite high. Interventional rates were high compared to international standards, and in particular the use of drug-eluting stents, yet the clinical outcomes (mortality, re-admission rates and severe bleeding episodes at one year) were favourable, with low rates compared with other studies. SN - 1680-0745 UR - https://www.unboundmedicine.com/medline/citation/22447241/Management_of_acute_coronary_syndrome_in_South_Africa:_insights_from_the_ACCESS__Acute_Coronary_Events___a_Multinational_Survey_of_Current_Management_Strategies__registry_ L2 - http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&amp;/AdvancedQuery?&amp;format=F&amp;next=images/ejour/cardio1/cardio1_v23_n7_a2.pdf DB - PRIME DP - Unbound Medicine ER -