Background and Purpose: The prospective registries are the most powerful evaluation tool to characterize patients and features of acute coronary syndrome (ACS) treatment. There have been a lot of changes in ACS treatment in Russian hospitals in recent 5-7 years. The aim of our study was to evaluate changes in the ACS treatment occurred in Russia during the last few years.
Methods: We conducted the series of independent registries of ACS which were organized by the initiative of their participants - RECORD registries. The first regi stry was held in 2007 (18 centers in 13 cities, n=796). The RECORD-2 registry was conducted in 2009-2011 (7 centers in 7 cities, n=1656). In this analysis pooled data of the RECORD and RECORD-2 (“old” registries; n=2452) were compared with data of the RECORD-3 (“new” registry), conducted in March-April 2015 (47 centers in 37 cities, n=2370).
Results: In comparison with “old” registries significantly more patients from “new” registry were hospitalized in PCI-capability hospitals (72.5% vs 56.7%; p<0.0001). The rate of troponin detection was also higher in “new” registry (75.7% vs 41.5%; p<0.0001). The rate of primary PCI (pPCI) in ST-elevation myocardial infarction (STEMI ) was 39.0% in “new” and 36.3% in “old” registry (p=0.24). The rate of pPCI in PCI-capability centers wasn’t also significantly higher in “new” registry (47.2% vs 45.8%). The rate of fibrinolysis in STEMI was nearly similar (32.1% vs 32.2%; p=0.98), but the rate of prehospital fibrinolysis and the rate of PCI after fibrinolysis became more frequent in “new” registry (50.9% vs 23.5%; p<0.0001 and 52.4% vs 25.0%; p<0.0001 respectively). In patients with non-ST elevation ACS (NSTEACS) the rate of diagnostic coronarography (CAG) and the rate of PCI within 72 hours after admission weren’t significantly different in “new” and “old” registries (68.2% vs 71.8%; p=0.15 and 26.6% vs 23.6%; p=0.19 respectively). Among discharge medication from “old” to “new” registries decreasing of aspirin and beta-blockers prescription (89.7% and 91.3%; p=0.009 and 86.0% vs 90.2%; p<0.0001 respectively) and increasing of dual antiplatelet therapy and statin prescription (82.6% vs 43.7%; p<0.0001 and 90.9% vs 78.1%; p<0.0001 respectively) were obtained.The duration of in-hospital stay in “new” registry was shorter than in “old” registries (10,2 vs 13.4 days; p<0.0001), the proportion of patients transferred in non-PCI-capability centers to CAG was higher (16.3% vs 2.2%; p<0.0001) and the rate of in-hospital death was lower (5.1% vs 6.6%; p=0.041).
Conclusion: A series of prospective independent registries RECORDs showed that in recent years some progress towards better adherence to the guidelines has been made in the treatment of ACS in Russian hospitals participating in those registries. However, there wasn’t a clear increase in the rate of pPCI and fibrinolysis in STEMI and the rate of invasive strategy in NSTEACS.