TRENDS IN MANAGEMENT AND OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROMES IN THE LAST DECADE: THE ACS ISRAELI SURVEY (ACSIS) EXPERIENCE


Shmuel Gottlieb, M.D., Jerusalem, Israel

Background: The management of acute coronary syndromes (ACS) patients has undergone major changes during the last decade. These changes reflect the results of numerous controlled clinical trials that established the basis for evidence-based guidelines.

Aims: To evaluate trends in the characteristics, management and outcome of patients with ACS hospitalized in all 26 Intensive Cardiac Care Units (ICCU) / Cardiology departments operating in public hospitals in Israel, during the last decade. Methods: Data were derived from 6 biennial nationwide prospective community-based two-month ACS Israeli Surveys (ACSIS) performed between 2000 and 2010.

Results: During this period, there was a 23% decline in the number of patients admitted with ACS that was more pronounced for STE (-38%) than for NSTE patients (-14%). The mean age of the patients (64 years) has not changed. The prevalence of risk factors and CV comorbidity increased. There has been an increasing use of evidence-based medications during hospital stay and at discharge, and the use of PCI with stent implantation. Primary reperfusion rate increased (from 56% in 2000 to 72% in 2010), and the mode of reperfusion significantly changed in favor of primary PCI (from 18% in 2000 to 97% in 2010). D2B time declined from 75 min to 68 min, while pre-hospital delay has not changed. A significant reduction in short- and long-term mortality was observed; with a reduction in 30-day mortality (from 8.5 to 4.1%, ORadj = 0.44 (0.32-0.61), and in 1-year mortality (from 13.5% to 7.8%, ORadj = 0.52 (0.42-0.65). In-hospital complications declined except major bleeding that increased. Length of hospital stay declined.

Conclusion: ACSIS demonstrates that high degree of implementation and adherence to recommended guidelines is associated with a continuous improvement in short- and long-term outcome of ACS patients in Israel. Nonetheless, more efforts are needed to further improve the outcome of ACS patients.