European Heart Journal Advance Access originally published online on October 11, 2005
European Heart Journal 2006 27(4):393-405; doi:10.1093/eurheartj/ehi557
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study
1S.M. Misericordia Hospital, Udine, Italy
2Italian Association of Hospital Cardiologist (ANMCO) Research Center, Via La Marmora 34, 50121 Florence, Italy
3Niguarda C' Granda Hospital, Milano, Italy
4San Giovanni Hospital, Rome, Italy
5Ospedale G.B. Morgagni and Fondazione Sacco, Forlì, Italy
6San Donato Hospital, Arezzo, Italy
7General Hospital, Legnano, Italy
8S. Corona Hospital, Pietra Ligure, Italy
Received 12 April 2005; revised 28 August 2005; accepted 8 September 2005; online publish-ahead-of-print 11 October 2005.
* Corresponding author. Tel: +39 0 432 554449; fax: +39 0 432 554448. E-mail address: dichiara.antonio{at}aoud.sanita.fvg.it
Aims Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network.
Methods and results The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24–2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021–1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020–2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734–1.660).
Conclusion According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
Key Words: Acute coronary syndromes • Coronary revascularization • Hospital epidemiology