Between 2005 and 2012 in the Czech Republic, the estimated incidence of ACS decreased primarily due to a reduction in unstable angina, while in-hospital mortality remained unchanged and evidence-based medication use at discharge increased.
Ăvod: Spektrum pacientĹŻ s akutnĂm koronĂĄrnĂm syndromem (AKS) se v dĹŻsledku postupnĂŠho stĂĄrnutĂ obyvatelstva v prĹŻbÄhu poslednĂch dvou desetiletĂ zmÄnilo.CĂl: Analyzovali jsme zmÄny v epidemiologii a v lĂŠÄebnĂ˝ch strategiĂch ve dvou velkĂ˝ch registrech, kterĂŠ byly v letech 2005 a 2012 provedeny u pĹesnÄ definovanĂ˝ch populacĂ ÄeskĂŠ republiky.Metody a vĂ˝sledky: Do registrĹŻ CZECH-1 a CZECH-2 byli zaĹazovĂĄni vĹĄichni po sobÄ jdoucĂ hospitalizovanĂ pacienti se vstupnĂ diagnĂłzou AKS v obdobĂ jednoho nebo dvou mÄsĂcĹŻ. RegistrĹŻ CZECH-1 a CZECH-2 se zĂşÄastnilo 36, respektive 32 nemocnic. Do registru CZECH-1 bylo zaĹazeno celkem 1 921 pacientĹŻ a do registru CZECH-2 celkem 1 221 pacientĹŻ. Pacienti zaĹazenĂ do registru CZECH-2 byli starĹĄĂ neĹž pacienti v registru CZECH-1 (68 ± 12 vs. 66 ± 12 let; p < 0,001). BÄhem hospitalizace nebyl AKS potvrzen u 30,5 % pacientĹŻ v registru CZECH-1 a 30,1 % (p > 0,05) pacientĹŻ v registru CZECH-2. UrgentnĂ angiografie u pacientĹŻ s infarktem myokardu s elevacemi Ăşseku ST (STEMI) byla provedena v 92 %, resp. 94 % pĹĂpadĹŻ (p > 0,05); z tohoto poÄtu byla v 87 %, resp. 89 % pĹĂpadĹŻ nĂĄslednÄ provedena primĂĄrnĂ PCI. Mezi registry neexistovaly ŞådnĂŠ rozdĂly v nemocniÄnĂ mortalitÄ (4,2 vs. 4,4 %; p = 0,805) ani v mortalitÄ pacientĹŻ s koneÄnou diagnĂłzou Q-infarktu myokardu (Q-IM) (10,3 vs. 10,7 %; p = 0,870) nebo non-Q infarktu myokardu (non-Q-IM) (4,7 vs. 3,8 %; p = 0,497). OdhadovanĂĄ incidence potvrzenĂŠho AKS a STEMI v reprezentativnĂm populaÄnĂm vzorku z obou registrĹŻ byla 3 248 a 661 pĹĂpadĹŻ/milion obyvatel/rok v registru CZECH-1 a 2 149 a 652 pĹĂpadĹŻ/milion obyvatel/rok v registru CZECH-2. Pokles incidence AKS byl tĂŠmÄĹ vĂ˝hradnÄ dĹŻsledkem statisticky vĂ˝znamnĂŠho poklesu incidence nestabilnĂ anginy pectoris jako koneÄnĂŠ diagnĂłzy. PĹi propuĹĄtÄnĂ byly pacientĹŻm s potvrzenĂ˝m AKS v registrech CZECH-1, resp. CZECH-2 pĹedepisovĂĄny nĂĄsledujĂcĂ lĂŠky: kyselina acetylsalicylovĂĄ (95 vs. 94 %; p > 0,05), clopidogrel (60 vs. 76,4 %; p < 0,001), beta-blokĂĄtory (78 vs. 78 %; p > 0,05), inhibitory enzymu konvertujĂcĂho angiotensin (50 vs. 78 %; p ≤ 0,001) a statiny (75 vs. 90 %; p < 0,001).ZĂĄvÄr: Mezi roky 2005 a 2012 se v ÄeskĂŠ republice zvýťil vÄk pacientĹŻ hospitalizovanĂ˝ch pro AKS. InvazivnĂ reperfuznĂ strategie u pacientĹŻ se STEMI byla v obou registrech pouĹžita ve vysokĂŠm procentu pĹĂpadĹŻ. CelkovĂ˝ osud pacientĹŻ s potvrzenĂ˝m AKS se mezi roky 2005 a 2012 nezmÄnil. OdhadovanĂĄ incidence AKS se snĂĹžila v dĹŻsledku poklesu poÄtu pacientĹŻ s nestabilnĂ anginou pectoris. AbstractBackground: The clinical spectrum of acute coronary syndrome (ACS) has changed due to a progressively ageing population over the last two decades.Aim: We analysed the changes in the epidemiological and treatment strategies between two large registries that were performed in 2005 and 2012 in well-defined populations of the Czech Republic.Methods and results: The CZECH-1 and CZECH-2 registries enrolled all consecutive hospitalized patients with an initial diagnosis of ACS during a 1- or 2-month period, respectively. Thirty-six and 32 hospitals participated in the CZECH-1 and CZECH-2 registries, respectively. A total of 1 921 patients were enrolled in the CZECH-1 registry and 1 221 patients participated in the CZECH-2 registry. Patients enrolled in the CZECH-2 registry were older than those in CZECH-1 (68 ± 12 vs. 66 ± 12 years; p < 0.001). ACS was not confirmed during hospitalization in 30.5 and 30.1% (p > 0.05) of the patients in the CZECH-1 and CZECH-2 registries, respectively. Urgent angiography in patients with ST segment elevation myocardial infarction (STEMI) was performed in 92 and 94% of the patients (p > 0.05), respectively; of these, 87 and 89% subsequently underwent primary PCI. There were no significant differences in in-hospital (4.2 vs. 4.4%, p = 0.805) or in the mortality of patients with a final diagnosis of Q-myocardial (10.3 vs. 10.7%; p = 0.870) or non-Q-myocardial infarction (4.7 vs. 3.8%; p = 0.497) between the two registries. The estimated incidence of confirmed ACS and STEMI in a representative population from both registries was 3 248 and 661 cases/million individuals/year in the CZECH-1 registry and 2 149 and 652 cases/million individuals/year in the CZECH-2 registry. The fall in ACS incidence was almost exclusively due to a significant decrease in the incidence of unstable angina as the final diagnosis. At discharge, the patients with confirmed ACS were administered the following medications: aspirin (95 vs. 94%; p > 0.05), clopidogrel (60 vs. 76.4%; p < 0.001), beta-blockers (78 vs. 78%; p > 0.05), angiotensin-converting enzyme (ACE) inhibitors (50 vs. 78%; p ≤ 0.001) and statins (75 vs. 90%; p < 0.001) in the CZECH-1 and CZECH-2 registries, respectively.Conclusion: In the Czech Republic, the age of the patients hospitalized with ACS increased between 2005 and 2012. Invasive reperfusion strategy for patients with STEMI was very high in both registries. The overall outcome in patients with confirmed ACS did not change between 2005 and 2012. The estimated incidence of ACS decreased due to the fall in unstable angina pectoris.
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Toušek et al. (2014) studied this question.
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