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Archivos de cardiología de México
versión On-line ISSN 1665-1731versión impresa ISSN 1405-9940
Resumen
MARTINEZ-SANCHEZ, Carlos y RENASICA III INVESTIGATORS et al. Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III). Arch. Cardiol. Méx. [online]. 2016, vol.86, n.3, pp.221-232. ISSN 1665-1731. https://doi.org/10.1016/j.acmx.2016.04.007.
Objective
To describe current management and clinical outcomes in patients hospitalized with an acute coronary syndrome (ACS) in Mexico.
Methods
RENASICA III was a prospective multicenter registry of consecutive patients hospitalized with an ACS. Patients had objective evidence of ischemic heart disease; those with type II infarction or secondary ischemic were excluded. Study design conformed to current quality recommendations.
Results
A total of 123 investigators at 29 tertiary and 44 community hospitals enrolled 8296 patients with an ACS (4038 with non-ST-elevation myocardial infarction/unstable angina [NSTEMI/UA], 4258 with ST-elevation myocardial infarction [STEMI]). The majority were younger (62 ± 12 years) and 76.0% were male. On admission 80.5% had ischemic chest pain lasting >20 min and clinical stability. Left ventricular dysfunction was more frequent in NSTEMI/UA than in those with STEMI (30.0% vs. 10.7%, p < 0.0001). In STEMI 37.6% received thrombolysis and 15.0% primary PCI. PCI was performed in 39.6% of NSTEMI/UA (early strategy in 10.8%, urgent strategy in 3.0%). Overall hospital death rate was 6.4% (8.7% in STEMI vs. 3.9% in NSTEMI/UA, p < 0.001). The strongest independent predictors of hospital mortality were cardiogenic shock (odds ratio 22.4, 95% confidence interval 18.3-27.3) and ventricular fibrillation (odds ratio 12.5, 95% confidence interval 9.3-16.7).
Conclusion
The results from RENASICA III establish the urgent need to develop large-scale regional programs to improve adherence to guideline recommendations in ACS, including rates of pharmacological thrombolysis and increasing the ratio of PCI to thrombolysis.
Palabras llave : Acute coronary syndromes; ST-elevation myocardial infarction; Non-ST elevation myocardial infarction; Unstable angina; Mexico.