Guideline Compliance in the Management of Patients with Unstable Angina/Non-STEMI without PCI Procedure (Medically Managed Registry)
Abstract
Aim: To document current usage of antiplatelet therapy and the implementation of ACC/AHA 2007 guideline in the clinical management of unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients not undergoing PCI procedure in Indonesia (medically managed) and their risks according to Global Registry of Acute Coronary Events (GRACE) score as well as in-hospital mortality.Method: A multicenter observational, prospective disease registry, recruiting patients with UA/NSTEMI. No specific treatment will be recommended in this disease registry. Data will be collected based on Physician’s applicable daily practices without any intervention.
Results: A total of 467 eligible patients, 246 patients with UA and 221 with NSTEMI, aged 18 years or older were recruited from 18 hospitals during December 2009 – January 2011. Most recruited patients were at low risk (63.9%) and only 0.9% patients were at high risk according to the GRACE score. Patients were treated with ASA (90.6%) and Clopidogrel (96.6%) when they reached the emergency department. Medical therapy instituted during hospitalization were injectable anticoagulant (91.4%), oral anticoagulant (0.9%), oral nitrate (82.7%), beta blocker (60.8%), ACE inhibitor (49%), angiotensin receptor blocker (20.3%), calcium channel blocker (19.9%), statin (13.1%), and other medications given according the presentation of complications or comorbidities. In-hospital mortality was documented in 3.2% of patients. At discharge ASA was given to 87.6% and clopidogrel to 94.2% patients.
Conclusion: The result showed that most of the patients admitted with UA/NSTEMI were at low or moderate risk according to GRACE score. Although treatment with antiplatelet and anticoagulant largely followed the ACC/AHA guidelines, however, this registry documented under treatment of other medications such as ACE-inhibitors and beta blockers. Reinforcement of the guideline compliance and continuous medical education would provide better outcomes for the patients.
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References
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Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494 – 502
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction). Circulation 2007; 116: e148 – e304.
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937 – 52
Eagle KA, Lim MJ,. Dabbous OH, Pieper KS, Goldberg RJ, Van de Werf F, Goodman SG, et al for the GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004; 291: 2727 – 2733
Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE Jr, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP. 2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 57: 1920 – 59
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Stephan Gielen, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J doi:10.1093/eurheartj/ehr236
Dagenais GR, Pogue J, Fox K, Simoons ML, Yusuf S. Angiotensin converting enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet 2006; 368: 581 – 588
Danchin N, Cucherat M, Thuillez C, Durand E, Kadri Z, Steg PG. Angiotensinconverting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized controlled trials. Arch Intern Med 2006; 166: 787 – 796
The National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia. Report on Result of National Basic Health Research (RISKESDAS) 2007.
Luepker RV, Raczynski JM, Osganian S, et al. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the Rapid Early Action for Coronary Treatment (REACT) trial. JAMA 2000; 284: 60 –7
Feldman HA, Proschan MA, Murray DM, et al. Statistical design of REACT (Rapid Early Action for Coronary Treatment), a multisite community trial with continual data collection. Control Clin Trials 1998; 19: 391 – 403
Leslie WS, Urie A, Hooper J, Morrison CE. Delay in calling for help during myocardial infarction: reasons for the delay and subsequent pattern of accessing care. Heart 2000; 84: 137 – 41
Rucker D, Brennan T, Burstin H. Delay in seeking emergency care. Acad Emerg Med 2001; 8: 163 – 9
Kiatchoosakun S, Wongvipaporn C, Buakhamsri A, Sanguanwong S, Moleerergpoom W, Sarakarn P, Silaruks S, Tatsanavivat P. Predictors of In-Hospital Mortality in Non-ST Elevation Acute Coronary Syndrome in Thai Acute Coronary Syndrome Registry (TACSR). J Med Assoc Thai 2007; 90 (Suppl 1): 41-50.
Montalescot G, Dallongeville J, Van Belle E, Rouanet S, Baulac C, Degrandsart A, Vicaut E for the OPERA Investigators. STEMI and NSTEMI: Are They So Different? 1 Year Outcomes in Acute Myocardial Infarction as Defined by the ESC/ACC Definition (the OPERA Registry). Eur Heart J 2007; 28: 1409 – 1417.
Chin SP, Jeyaindran S, Azhari R, Wan Azman WA, Omar I, Robaayah Z, Sim KH. Acute Coronary Syndrome (ACS) Registry - Leading the Charge for National Cardiovascular Disease (NCVD) Database. Med J Malaysia 2008; 63(Suppl C): 29 – 36
Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494 – 502
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction). Circulation 2007; 116: e148 – e304.
Published
2016-03-03
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How to Cite
Erwinanto, E., Widya, A., Taufik, N., Diniharini, S., Kaunang, D., & Setiawati, A. (2016). Guideline Compliance in the Management of Patients with Unstable Angina/Non-STEMI without PCI Procedure (Medically Managed Registry). Indonesian Journal of Cardiology, 36(3), 130-7. https://doi.org/10.30701/ijc.v36i3.475
Section
Clinical Research
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