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European Heart Journal Advance Access published online on October 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi557
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received April 12, 2005
Revised August 28, 2005
Accepted September 8, 2005

Clinical research

Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study

Antonio Di Chiara 1*, Claudio Fresco 2, Stefano Savonitto 3, Cesare Greco 4, Donata Lucci 5, Lucio Gonzini 5, Antonio Mafrici 3, Filippo Ottani 6, Leonardo Bolognese 7, Stefano de Servi 8, Alessandro Boccanelli 4, Aldo P. Maggioni 5, Francesco Chiarella 9, and on behalf of the BLITZ-2 Investigators

1 S.M. Misericordia Hospital, Udine, Italy; Italian Association of Hospital Cardiologist (ANMCO) Research Center, Via La Marmora 34, 50121 Florence, Italy
2 S.M. Misericordia Hospital, Udine, Italy
3 Niguarda C' Granda Hospital, Milano, Italy
4 San Giovanni Hospital, Rome, Italy
5 Italian Association of Hospital Cardiologist (ANMCO) Research Center, Via La Marmora 34, 50121 Florence, Italy
6 Ospedale G.B. Morgagni and Fondazione Sacco, Forlì, Italy
7 San Donato Hospital, Arezzo, Italy
8 General Hospital, Legnano, Italy
9 S. Corona Hospital, Pietra Ligure, Italy

* To whom correspondence should be addressed.
Antonio Di Chiara, E-mail: dichiara.antonio{at}aoud.sanita.fvg.it


  Abstract

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.

Keywords: Acute coronary syndromes; Coronary revascularization; Hospital epidemiology.
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