Resultados Chilenos del Registro Internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST; ACCORD. (ACute CORonary syndrome Descriptive study).

Resumen

Background: Coronary disease is an important cause of morbility and mortality. Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however current practices are unknown in Chile.

Aim: To evaluate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors.

Material and methods: One year prospective International non interventional registry, conducted in Chile between January 2005 and November 2006.

Results: 233 Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end of the follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures during the hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). During procedures, 31% of patients received clopidogrel, and 4.2% GP IIb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite more risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end of the 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%).

Conclusions: A high prevalence of multiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and, importantly decreases during the 1 year-follow-up.