Cor Vasa 2013, 55(3):e207-e211 | DOI: 10.1016/j.crvasa.2013.04.007

The use of revascularization strategies in patients with acute coronary syndromes admitted to hospitals without catheterization facilities: Results from the ALERT-CZ registry

Petr Widimský^a,*, Jana Zvárová^b, Zdeněk Monhart^c, Petr Janský^d

^a III. interní-kardiologická klinika, Kardiocentrum 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha, Česká republika

^b EuroMISE centrum, Ústav informatiky, Akademie věd ČR, Praha, Česká republika

^c Interní oddělení, Nemocnice Znojmo, Znojmo, Česká republika

^d Kardiochirurgická klinika, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Motol, Praha, Česká republika

^e Viz apendix pro úplný seznam řešitelů registru

Aim: Percutaneous coronary intervention (PCI) became the standard of care for patients (pts) with acute coronary syndromes (ACS). The Czech Republic is among European countries with well developed networks of PCI and non-PCI hospitals. Ample data about PCI-treated pts is available from many registries. Much less is known about treatments and outcomes of ACS pts admitted to hospitals without cath-lab. ALERT-CZ registry was designed specifically to analyze these patients presenting to local non-PCI hospitals. The aim was to see, whether the ESC guidelines are implemented in these local, small hospitals.

Methods and results: A total of 6265 pts with first hospital admission for ACS has been enrolled in 32 Czech community hospitals without cath-lab during a 3-year period (7/2008-6/2011). The mean age was 69.7 ±12,3 years, 39.5% were females, 35.4% had known diabetes mellitus, 76.0% hypertension, 28.3% previous myocardial infarction and 12.0% previous stroke. Twenty-five percent of pts had signs of acute heart failure (Killip II in 19.0%, Killip III in 4.8% and Killip IV in 1.1%). The discharge diagnosis was ST-elevation myocardial infarction (STEMI) in 26.1%, non-STEMI in 53.1% and unstable angina pectoris (UAP) in 20.9%.
Emergent interhospital transport to coronary angiography (CAG) and PCI within < 12 h from symptom onset was indicated in 73.4% of STEMI pts, elective CAG was indicated in 15.9% of STEMI, CAG was not indicated in 9.9% of STEMI and 0.9% STEMI pts refused CAG. Among non-STE ACS pts CAG was performed within < 24 h in 16.2%, between 24-72 h in 18.2%, later in 38.1%, not indicated in 22.7%, refused by pts in 4.8%. The median stay in the PCI center was 2.0 days and only 37% pts returned after CAG (± PCI) to the referring community hospital, the rest was discharged from PCI center directly to home.
Among STEMI pts the median time intervals were: pain - first medical contact (FMC) 120 min, FMC - community hospital door 30 min, door-in-door-out for emergency transfer 23 min. Thrombolysis was used in 0.4% of STEMI - in rare situations when immediate transfer was logistically not possible.
PCI was performed in 41.6% pts overall (65.9% STEMI, 35.8% non-STEMI and 26.4% UAP). CABG was performed in 2.9% pts overall (2.1%, 3.1% and 3.6% per diagnosis). Detailed pharmacotherapy data as well as indirect comparison with a separate PCI centers registry is beyond the space frame of this abstract and will be presented.
The overall in-hospital mortality was 7.2%. Mortality per final diagnosis was 9.5% (STEMI), 8.7% (non-STEMI) and 0.5% (UAP). Mortality per age group was 16.2% (> 80 years), 8.0% (70-80 years) and 2.4% (< 70 years).

Conclusion: Patients presenting to non-PCI hospitals undergo revascularization procedures less frequently than those directly admitted to PCI centers. This may be related to baseline differences. The outcomes are influenced by these facts.

Keywords: Acute coronary syndrome; Coronary angiography; Myocardial infarction; Non-PCI hospital; Percutaneous coronary intervention; Revascularization; Unstable angina

Received: March 20, 2013; Revised: April 22, 2013; Accepted: April 23, 2013; Published: June 1, 2013  Show citation