MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado) study. General findings
Ignacio Ferreira-González, Gaietà Permanyer-Miralda, Jaume Marrugat, Magda Heras, José Cuñat, Emilia Civeira, Fernando Arós, Juan J Rodríguez, Pedro L Sánchez, Héctor Bueno, MASCARA study research team, Radován, Maulén, Ortiz de Murua, Marcos, Arribas, Laperal, Casado, Bisbe, Bartomeu, Carrillo, Asunción Mateu, Gutiérrez, Benítez, de Miguel, Martínez, Soriano, Arias, Isabel Gómez, Ortega, Molina, Herreros, Azcárate, Worner, Piqué, Purificación Cascant, Salvador, Aguar, Arós, Sanz, Velasco, Belchi, Pagola, M Amparo Pérez, Sogorb, Oliver, Teresa Martorell, Bórqued, Verbal, Esplugues, Ribas, Cristina Carvajal, Martín, Pabón, Froufe, León, Montes, Poveda, Ruiz, Marta Calvo, Alcalde, Alguersuari, Otaegui, Purificación Cascant, Juan, Barrio, Estévez, Moreno, Martín, Fernández Avilés, Sánchez, Bruguera, Soriano, Recasens, Abizanda, Micó, Huelmos, Ortigosa, Silva, Bardají, Serrano, Purificación Cascant, Sala, Isabel Ramió, Ruth Martí, Montón, Ignacio Ferreira-González, Gaietà Permanyer-Miralda, Jaume Marrugat, Magda Heras, José Cuñat, Emilia Civeira, Fernando Arós, Juan J Rodríguez, Pedro L Sánchez, Héctor Bueno, MASCARA study research team, Radován, Maulén, Ortiz de Murua, Marcos, Arribas, Laperal, Casado, Bisbe, Bartomeu, Carrillo, Asunción Mateu, Gutiérrez, Benítez, de Miguel, Martínez, Soriano, Arias, Isabel Gómez, Ortega, Molina, Herreros, Azcárate, Worner, Piqué, Purificación Cascant, Salvador, Aguar, Arós, Sanz, Velasco, Belchi, Pagola, M Amparo Pérez, Sogorb, Oliver, Teresa Martorell, Bórqued, Verbal, Esplugues, Ribas, Cristina Carvajal, Martín, Pabón, Froufe, León, Montes, Poveda, Ruiz, Marta Calvo, Alcalde, Alguersuari, Otaegui, Purificación Cascant, Juan, Barrio, Estévez, Moreno, Martín, Fernández Avilés, Sánchez, Bruguera, Soriano, Recasens, Abizanda, Micó, Huelmos, Ortigosa, Silva, Bardají, Serrano, Purificación Cascant, Sala, Isabel Ramió, Ruth Martí, Montón
Abstract
Introduction and objectives: To investigate the clinical characteristics and treatment of acute coronary syndromes (ACS), and to determine the effects of an early invasive strategy (EIS) in non-ST-elevation ACS (NSTEACS) and of primary percutaneous coronary intervention (PCI) in ST-elevation ACS (STEACS).
Methods: Data were collected prospectively for 9 months during 2004-2005 from 50 hospitals, which were randomly selected according to the level of care provided. In addition, follow-up data on mortality and readmission for ACS were collected for 6 months. The adjusted effects of different reperfusion strategies were analyzed.
Results: After checking data quality, the analysis included data from 32 hospitals, which covered 7923 coronary events (4431 [56%] STEACS, 3034 [38%] NSTEACS and 458 [6%] unclassified ACS) in 7251 patients. Compared with previous studies, the use of primary PCI in STEACS had increased markedly (from 10.7% to 36.8% of patients undergoing reperfusion), as had the use of EIS in NSTEACS (from 11.1% to 19.6%). Overall in-hospital mortality was 5.7% (95% confidence interval [CI], 5.1%-6.2%); for STEACS it was 7.6% (95% CI, 6.7%-8.7%), for NSTEACS 3.9% (95% CI, 3.3%-4.6%), and for unclassified ACS 8.8% (95% CI, 6.2%-12.2%). In the population as a whole, there was no association between prognosis (i.e., 6-month mortality) and EIS in NSTEACS (hazard ratio [HR]=0.94; 95% CI, 0.66-1.3) or between prognosis and primary PCI in STEACS (HR=1; 95% CI, 0.7-1.5). Findings for mortality and rehospitalization for ACS at 6 months were similar.
Conclusions: Data for 2004-2005 demonstrated a marked increase in the use of invasive procedures. However, the procedures employed were poorly matched to the patients' baseline risk.
Source: PubMed