The ENACT study: a pan-European survey of acute coronary syndromes

Fox, Keith

doi:10.1053/euhj.2000.2185

Cited by 208 publications

(116 citation statements)

References 22 publications

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“…National 7 and international 8 guidelines with recommendations for treatment have been developed based on randomized clinical trials conducted with geographically restricted populations and patients who strictly met the criteria for inclusion 1,3 .…”

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confidence: 99%

“…These manifestations are common causes of medical consultations and admissions at emergency departments, as well as morbidity and mortality worldwide [1][2][3][4] . USA epidemiological data show that more than 12 million people suffer from coronary artery disease and more than one million suffer myocardial infarction each year, accounting for approximately 466,000 deaths per year due to coronary artery disease 1,5 .…”

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confidence: 99%

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Registro de síndrome coronariana aguda em um centro de emergências em cardiologia

Santos¹,

Minuzzo²,

Pereira³

et al. 2006

Arq. Bras. Cardiol.

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objective: Describe clinical characteristics of patients (P) admitted to hospital with suspected acute coronary syndrome (ACS), identifying medical treatment and in-hospital mortality.Methods: Evaluated were 860 patients with ACS from January through December, 2003. We evaluated baseline characteristics, ACS mode of presentation, medication during hospital stay, indication for clinical treatment or myocardial revascularization (MR) and in-hospital mortality.Results: Five hundred and three (58.3%) were male, mean age 62.6 years (± 11.9). Seventy-eight (9.1%) were discharged with the diagnosis of acute ST-elevation myocardial infarction (STEMI), 238 (27.7%) with non-ST-elevation myocardial infarction (non-STEMI), 516 (60%) with unstable angina (UA), two (0.2%) with atypical manifestations of ACS and 26 (3%) with noncardiac chest pain. During hospitalization, 87.9% of patients were given a beta-blocker, 95.9% acetylsalicylic acid, 89.9% anti-thrombin therapy, 86.2% intravenous nitroglycerin, 6.4% glycoprotein (GP) IIb/IIIa receptor inhibitor, 35.9% clopidogrel, 77.9% angiotensin-converting enzyme inhibitor, and 70,9% statin drugs. Coronary arteriography was performed in 72 patients (92.3%) with STEMI, and in 452 (59.8%) with non-STEMI ACS (p< 0.0001). Myocardial revascularization (MR) surgery was indicated for 12.9% and percutaneous coronary intervention for 26.6%. In-hospital mortality was 4.8%, and no difference was recorded between the proportion of deaths among patients with STEMI and non-STEMI ACS (6.4% versus 4.8%; p = 0.578). Conclusion:In this registry, we provide a description of ACS patient, which allows the evaluation of the demographic characteristics, medical treatment prescribed, and in-hospital mortality. A greater awareness of our reality may help the medical community to adhere more strictly to the procedures set by guidelines.key words: Acute coronary syndrome, registry, chest pain, unstable angina, acute myocardial infarction.

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confidence: 99%

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confidence: 99%

Registro de síndrome coronariana aguda em um centro de emergências em cardiologia

Santos¹,

Minuzzo²,

Pereira³

et al. 2006

Arq. Bras. Cardiol.

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“…Intraregional variability in cardiovascular disease management has also been suggested in Europe. 5 While differences in delivery of both complex and noncomplex interventions for CV disease management are important, differences in the nonpharmacologic aspects of these interventions, as well as patient characteristics at baseline may also contribute. 7,8,22 Data from INVEST provide an opportunity to investigate global differences in patient characteristics, care for stable hypertensive patients with CAD, and outcomes in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] These data primarily come from registries of non-ST-elevation ACS and myocardial infarction (MI) where management is highly technical and complex. [2][3][4][9][10][11] Regional differences in noncomplex CV care required for hypertension and diabetes management have also been documented.…”

Section: Introductionmentioning

confidence: 99%

Global differences in blood pressure control and clinical outcomes in the INternational VErapamil SR‐Trandolapril Study (INVEST)

Zineh

Cooper‐DeHoff

Wessel

et al. 2005

Clinical Cardiology

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Background: The INternational VErapamil SR‐Trandolapril Study (INVEST), a prospective, randomized, antihypertensive trial, found that two different medication regimens produced similar blood pressure (BP) control with equivalent cardiovascular (CV) outcomes (death from any cause, nonfatal myocardial infarction [MI], or nonfatal stroke). Hypothesis: The study was undertaken to investigate whether differences exist by global regions in demographics, treatment, and outcomes in the INVEST trial. Methods: Data were analyzed for 22,576 patients with stable coronary artery disease (CAD) enrolled in INVEST. We investigated differences in patient characteristics, treatment approaches, BP control, and clinical outcomes by creating three global regions based on geographical location: Northern Americas (NA), Caribbean (CA), and Eurasia (EA). Results: We observed significant regional differences in patient characteristics, treatment patterns, BP control, and CV outcomes. At baseline, patients from NA were older and had greater body mass index, higher rates of diabetes, peripheral vascular disease, and coronary revascularization, but lower rates of MI or left ventricular hypertrophy than patients in CA and EA. At 24 months, there were regional differences in both study and nonstudy antihypertensive drug use. Despite having higher mean baseline BP, patients from CA and EA achieved lower mean systolic BP throughout study follow‐up. Furthermore, patients from both CA and EA had lower rates of all‐cause mortality, fatal or nonfatal MI, fatal or nonfatal stroke, and newly diagnosed diabetes than patients from NA. Conclusions: In INVEST, regional differences in medication utilization, BP control, and CV outcomes were identified. These disparities warrant further investigation to define appropriate care for patients with hypertension and stable CAD from an international public health perspective.

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“…First, the proportion of ST-segment elevation myocardial infarction (STEMI) is higher in Japan than in Western countries 16,17) . Second, the rate of reperfusion therapy for ACS is much higher in Japan (85-95%) compared to Western countries (40-50%) [16][17][18] . Third, the mortality rate following ACS appears to be lower in Japan compared to Western countries [16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Five-year Long-term Outcomes of Acute Coronary Syndrome with General Practitioner-based Management: Myocardial Infarction Cohort Study by Kanfuzen Study (MIC-K) Study

Kiuchi¹,

Obayashi

Ishikawa³

et al. 2017

J Jpn Coron Assoc

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Background: Only a few nationwide studies have focused on the post-discharge treatment and outcomes of acute coronary syndrome (ACS) by general practitioners. Methods and Results: This prospective cohort study was conducted between February 2007 and March 2011. In total, 178 facilities across the country participated in this study, which included 545 patients with ACS who received acute care in cardiovascular centers and were then referred to general practitioners for further care. Clinical follow-up data, of up to 5 years, were obtained. As for patient characteristics, 403 of the 545 patients (73.9%) were men. The mean age of all subjects was 66 ± 11 years. Approximately two-thirds of patients had hypertension and dyslipidemia, and one-third had diabetes mellitus. Only 3.5% of patients had renal dysfunction. In the cardiovascular centers, reperfusion therapy was administered as acute care to 516 of the 545 patients (94.7%). Frequent use of guideline-directed medical therapy was indicated during the in-hospital and post-discharge periods. During the 5-year follow-up period, the cumulative incidence of clinical events was 24.0%, and all-cause mortality was 5.3%. The number of affected vessels was the strongest independent predictor of cardiovascular events. Conclusions: The MIC-K study identified an incidence of clinical events of 24.0%, and that of mortality of 5.3% in patients with ACS who were managed by general practitioners following their discharge from cardiovascular centers. The high rate of reperfusion therapy administered in cardiovascular centers and a low complication rate may have contributed to the favorable outcomes in these patients.

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The ENACT study: a pan-European survey of acute coronary syndromes

Cited by 208 publications

References 22 publications

Registro de síndrome coronariana aguda em um centro de emergências em cardiologia

Registro de síndrome coronariana aguda em um centro de emergências em cardiologia

Global differences in blood pressure control and clinical outcomes in the INternational VErapamil SR‐Trandolapril Study (INVEST)

Five-year Long-term Outcomes of Acute Coronary Syndrome with General Practitioner-based Management: Myocardial Infarction Cohort Study by Kanfuzen Study (MIC-K) Study

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