Objective: To determine whether the guidelines for the management of acute coronary syndrome (ACS) are being applied in daily clinical practice, and in what ways the management differs between the Netherlands and other member countries of the European Society of Cardiology (ESC).
Design: Prospective, observational study.
Method: Patients with a confirmed diagnosis of ACS who were enrolled in 6 Dutch hospitals and in 97 hospitals in 24 other ESC member countries in the period from 4 September 2000 to 15 May 2001 were included. Data were collected on the acute treatment and secondary prevention in patients with ST-elevation and on the pharmacotherapy, risk stratification and secondary prevention in patients without ST-elevation. The findings were compared with the recommendations and guidelines of the ESC.
Results: A total of 223 patients with ST-elevation and 198 patients without ST-elevation were enrolled in the Netherlands, plus 4208 and 5169 patients, respectively, in the other European countries. The median age was 64-67 years and the percentage of males was 64-73. Of the patients with ST-elevation who arrived in the hospital within 12 hours after the onset of symptoms, 35% received neither thrombolysis nor primary percutaneus coronary intervention. In both the Netherlands and the rest of Europe, half of the ST-elevation patients received thrombolysis later than 40 minutes and primary percutaneous coronary intervention later than 90 minutes after arrival in the hospital. Risk stratification using troponin measurements was applied more often in the Netherlands. Of the high-risk patients without ST-elevation, over 50% in both the Netherlands and the rest of Europe underwent coronary angiography. Almost 70% and 80% of low-risk, non-ST-elevation patients underwent an exercise tolerance test or coronary angiography. In the Netherlands, clopidogrel, glycoprotein IIb/IIIa antagonists and statins were prescribed more often and ACE inhibitors less often.
Conclusion: Guidelines for the management of ACS were followed to a moderate extent in both the Netherlands and the rest of Europe. The management differed in a number of ways between the Netherlands and the other countries.