Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit

Rev Esp Cardiol (Engl Ed). 2016 Aug;69(8):754-9. doi: 10.1016/j.rec.2015.12.021. Epub 2016 Mar 12.
[Article in English, Spanish]

Abstract

Introduction and objectives: Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome.

Methods: A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol.

Results: The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications.

Conclusions: After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.

Keywords: Acute coronary syndrome; Código infarto; Infarction code; Mortalidad; Mortality; Revascularización; Revascularization; Síndrome coronario agudo.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / surgery*
  • Aged
  • Cardiac Catheterization / methods*
  • Coronary Angiography
  • Coronary Care Units*
  • Diagnosis, Differential
  • Electrocardiography
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Myocardial Infarction / diagnosis*
  • Myocardial Revascularization / methods*
  • Prognosis
  • Risk Assessment*
  • Spain / epidemiology
  • Treatment Outcome