Key result
Contemporary management of acute coronary syndromes was associated with increased use of PCI, drug-eluting stents, dual antiplatelet therapy, and ticagrelor (all P<0.001) compared to earlier practice.
Why the study?
How have the demographics and management of patients with acute coronary syndromes evolved in contemporary real-world practice in Italy?
Observational (n=3,756)
Yes
How have the demographics and management of patients with acute coronary syndromes evolved in contemporary real-world practice in Italy?
Contemporary real-world management of ACS in Italy demonstrates an increased adoption of invasive strategies and newer antiplatelet therapies, which is associated with improved in-hospital outcomes.
Reflects real-world uptake of invasive ACS strategies in Italy; extends temporal trends but leaves open outcome causality.
The epidemiology and management of patients with acute coronary syndromes (ACSs) have evolved. We aimed to describe recent demographics and therapeutic changes in the Italian ACS population. We analyzed data from 2 multicenter consecutive Italian registries (the EYESHOT [EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalised in iTalian cardiac care units] and START-ANTIPLATELET registries) enrolling patients with ACS between December 2013 and June 2016. An overall population of 3756 patients with ACS was enrolled: 2585 in the EYESHOT and 1171 in the START-ANTIPLATELET. Compared with the EYESHOT, patients in the START-ANTIPLATELET registry presented more frequently with ST-segment elevation myocardial infarction and were more often smokers and dyslipidemic (all P < .001) and had atrial fibrillation ( P = .018) but were less frequently aged ≥75 years and with a history of major bleeding (all P < .001). Analysis of treatment strategy showed a significant increase in the use of percutaneous coronary intervention, drug-eluting stents, dual antiplatelet therapy, and ticagrelor in the START-ANTIPLATELET (all P < .001), with a substantial decline in the proportion of patients conservatively managed and on clopidogrel at discharge ( P < .001). A lower rate of in-hospital events was recorded in the START-ANTIPLATELET compared with the EYESHOT. The START-ANTIPLATELET and EYESHOT registries provide consecutive snapshots in the contemporary management of patients with ACS in Italy, showing important changes in both demographic characteristics and treatment strategies.
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Calabrò et al. (2018) conducted an observational in Acute coronary syndromes (n=3,756). Contemporary management (START-ANTIPLATELET registry) vs. Historical management (EYESHOT registry) was evaluated on Use of percutaneous coronary intervention, drug-eluting stents, dual antiplatelet therapy, and ticagrelor (p=<.001). Contemporary management of acute coronary syndromes was associated with increased use of PCI, drug-eluting stents, dual antiplatelet therapy, and ticagrelor (all P<0.001) compared to earlier practice.
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