Codzienna praktyka kliniczna w ostrych zespołach wieńcowych bez uniesienia odcinka ST w szpitalach rejonowych — rejestr w Małopolsce Everyday treatment strategies of non ST-segment elevation acute coronary syndromes in hospitals without on-site invasive facility — The Malopolska Registry

Background: Non ST-segment elevation acute coronary syndromes (NSTE ACS) account for more than half of patients diagnosed with acute coronary syndrome (ACS). Because of the 24-hour availability of invasive facility in the Malopolska Region every NSTE ACS high risk patient admitted to a community hospital can be transferred to the invasive facility center in Krakow. The aim of this study was to assess the frequency of transfer of NSTE ACS patients to catheterization as well as baseline characteristics and applied treatment strategies. Material and methods: Data on 2382 consecutive patients diagnosed with acute coronary syndrome admitted to community hospitals in Malopolska Region from April 2002 to Febru- ary 2003 were researched. In 1396 of these patients discharge diagnosis of non ST-segment elevation acute coronary syndrome was confirmed. Results: Elevated cardiac necrosis markers such as troponin T/I or CK MB were found in 42% (n = 582) of patients with NSTE ACS discharge diagnosis (CM+) whereas 58% (n = 814) had no elevation of these markers (CM-). Higher in-hospital mortality was observed in CM+ group in comparison to CM- group (3.3% vs. 0.4%; p = 0.0002). Only 17.7% of NSTE ACS CM+ patients were transferred for angiography to invasive facility center in Krakow. Simul- taneously with the growth of risk assessed by the TIMI Risk Score classification, percentage of patients transported for angiography increased (TIMI Risk Score 0-2 points: 14%; 3-4 points: 15%; 5-7 points: 22%; p = 0,02 for 3-4 vs. 5-7 and p = 0,01 for 0-2 vs. 5-7). In-hospital mortality for patients remaining for conservative treatment in the corresponding groups also increased 0.8% vs. 1.9% vs. 3.5% (p = 0.02 for 0-2 vs. 5-7) TIMI Risk Score 0-2 vs. 3-4 vs.