Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2)

Abstract

ObjectivesTo assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS).Setting11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran.ParticipantsPatients aged ≥20 and ≤80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA).Primary and secondary outcome measuresPatients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds.ResultsA total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients.ConclusionsOur study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study

“…Another reason could also be due to delayed admission time to the hospital, where the mean time of presentation was around four days. In contrary, the finding of the present study was lower than reports from Iran 17.3% [33], South Africa 53%(31), Kenya 38% [35], Greece 27.0% [36] and Ethiopia 65.3% [37]. Possibly, the inconsistency is due to wide accessibility of PCI service in these areas.…”

“…Another plausible reason could be lack of adequate accessibility and affordability of the medication in relation to the socio-economic status of the patients. Our study revealed a lower percentage of thrombolytic use compared to studies from Kenya 79.5% [30], South Africa 18% [31], sub-Saharan countries 44.4% [32] and Iran 46.3% [33]. This could be due to better availability and accessibility of thrombolytic medications in Kenya, South Africa and similarly in Iran too.…”

Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review

“…The methodological quality assessment indicated that the quality of 36 included studies was excellent or good [ 12 , 13 , 19 , 23 - 25 , 27 - 38 , 40 , 41 , 44 , 45 , 47 , 48 , 50 - 60 , 64 ], whereas the quality of seven studies was scored moderate [ 26 , 42 , 46 , 49 , 61 , 62 , 63 ] and two studies were scored poor [ 39 , 43 ] (Table 1 )). Most studies lacked a detailed description of primary and secondary outcomes and related measurement sources, the handling of missing data, and/or the adjustment for confounders in multivariable analyses.…”

Evaluation of door-to-balloon time for performing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients transferred by pre-hospital emergency system in Tehran

“…In the study of Kassaian et al (2015), in Tehran city, it was reported as 30 min. [ 21 ] Moreover, the time interval between visit by the doctor to leave the emergency ward was reported as 51 min. [ 22 ] These results were not consistent with those of the present study as the time interval for leaving the emergency ward was 76 min.…”