Portuguese Registry of Acute Coronary Syndromes: seven years of activity.

BACKGROUND: The Portuguese Registry of Acute Coronary Syndromes was established in 2002, with the goal of gathering data on the clinical characteristics, treatment and prognosis of Portuguese patients with acute coronary syndromes (ACS).

OBJECTIVE: To report the information collected during the seven years of activity of the Portuguese Registry of ACS (from January 1, 2002 to December 31, 2008).

METHODS: The Portuguese Registry of ACS is an observational, prospective and continuous registry, which started on January 1, 2002 and involved 45 Portuguese hospitals. Patients with ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) were included. Information was collected on 188 variables, including data on clinical presentation, treatment and prognosis of patients with ACS.

RESULTS: The registry included 22,482 patients (mean age 66 +/- 13 years, 70% male), distributed as follows: 45.4% STEMI, 41.4% NSTEMI and 13.1% UA. Reperfusion therapy was used in 63% of STEMI patients, ris- ing from 60% in 2002 to 75% in 2008, with an increasing proportion of primary angioplasty relative to fibrinolysis. Aspirin, low molecular weight heparin and glycoprotein IIb/IIIa inhibitors were used in respectively 97%, 88% and 26% of the patient population. A combination of dual antiplatelets, beta-blockers, angiotensin-converting enzyme inhibitors and statins was used in 32% of patients during hospitalization, in 26% on discharge and in 16% six months after the acute event. Coronary angiography was performed in the majority of patients (62%), followed by a coronary revascularization procedure in about a third (38%). Coronary angiography was increasingly used during the period under analysis, with a concomitant increase in revascularization procedures. In-hospital mortality was 5.2% in the overall population (7.7% in STEMI, 3.9% in NSTE-MI and 0.7% in UA), declining significantly over time. Cumulative mortality six months after the acute event was 7.5% (10.2% in STEMI, 6.6% in NSTEMI and 1.5% in UA).

CONCLUSION: The Portuguese Registry of ACS has collected crucial information on the clinical characteristics, treatment and prognosis of ACS in Portugal. The reported results reveal discrepancies between the guidelines for ACS treatment and their application in clinical practice. Analysis of the results has identified several issues that require particular attention and future intervention in order to improve ACS treatment and prognosis.