Copyright © 2000 by the European Society of Cardiology.
The ENACT study: a pan-European survey of acute coronary syndromes
a Cardiovascular Research, Department of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, U.K.
b Cardiology Department, Onassis Cardiac Center, Athens, Greece
c Thoraxcentrum-Academisch Ziekenhuis, Erasmus University, Rotterdam, The Netherlands
d Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Germany
e ANMCO Research Center, Florence, Italy
f Groupe Hospitalier Bichat—Claude Bernard, Paris, France
Abstract
Aim The European Network for Acute Coronary Treatment (ENACT) study was designed to collect prospective information across Europe on the relative frequency, diagnosis and management of the whole spectrum of acute coronary syndromes.
Methods Cardiologists, who were respondents to mailings sent out to 17 European countries with the target of reaching one centre per million inhabitants, completed a prospective patient record, each physician providing information on 10 consecutive patients with a working diagnosis on admission of acute coronary syndrome, and a questionnaire.
Results A total of 390 responses were received (0·91/106population) with data on 3092 patients in 29 countries. The patient population comprised 1431 (46%) with an initial working diagnosis of unstable angina/non-ST-segment elevation myocardial infarction, 1205 (39%) with myocardial infarction and 445 (14%) with suspected acute coronary syndrome. The ratio of unstable angina to myocardial infarction was 1·2:1 and this was similar across Europe. An initial diagnosis of myocardial infarction was more likely to be confirmed than unstable angina or suspected acute coronary syndrome. There were wide variations in the rates of angiography and percutaneous coronary intervention across Europe. Most unstable angina patients received aspirin, nitrates and heparin (unfractionated heparin 44% intravenous, 16% subcutaneous; low-molecular-weight heparin 50%). Overall, 50% of unstable angina patients and 34% of myocardial infarction patients received low-molecular-weight heparin and 6% and 8% respectively received a glycoprotein IIb/IIIa inhibitor, but there were large inter-country differences. There were also national differences in the use of calcium antagonists, angiotensin-converting enzyme inhibitors and beta-blockers.
Conclusion The ENACT study provides robust data, for the first time, on the relative frequency of unstable angina and acute myocardial infarction across Europe. It provides insight into differences in management across Europe and a reference benchmark of current treatment.
Key Words: Unstable angina, myocardial infarction, acute coronary syndrome, management, medication
f1 Correspondence: Professor Keith A. A. Fox, Cardiovascular Research, Department of Medical and Radiological Sciences, The University of Edinburgh, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, U.K.
f2 http://wwww.acc.org/clinical/guidelines
f3 http://www.americanheart.org
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