Management of acute coronary syndrome at the Institute of Emergency Services of Novi Sad

Introduction: Acute coronary syndrome (ACS) involves a group of different clinical conditions occurring as the result of acute ischemia and/or myocardial necrosis most often caused by acute coronary lesion occurring due to atherosclerotic plaque rupture in the coronary artery followed by thrombosis, inflammation, vasoconstriction and microembolization. Aim: To present the frequency of confirmed ACS diagnosis, prehospital diagnostics and treatment, modes of hospital management, as well as the influence of these factors on short-term survival. Methods: We performed a retrospective observational study. The study involved patients who were examined at the Institute of Emergency Services (IES) of Novi Sad in the period from January 1, 2009 to December 31, 2009, and then under suspicion of ACS transferred to the Institute for Coronary Vascular Diseases of Vojvodina in Sremska Kamenica ICVD), where the diagnosis was confirmed at the outpatients admission unit. Data were analyzed using a statistical package SPSS 11 and Statistica 7. Results: During the 12-months period, field teams of the IES Novi Sad examined 31.757 patients. Suspected ACS was made in 938 (2.95%) patients. The diagnosis was confirmed in 441 (1.39%) of the examined patients at the outpatients admission unit of the ICVD in Sremska Kamenica. Acute myocardial infarction ST-segment elevation (STEMI) was confirmed in 295 (66.89%), and acute myocardial infarction without ST-segment elevation (non-STEMI) in 146 (33.11%). Mean Patients' age was 66 years. 61.68% of patients were male. 11.56% were hypotensive, 5.67% had marked bradycardia, while 9.98% had low capillary blood oxygen level. Prehospitally, a complete MONA therapy was applied in 49.43% patients. During hospitalization, in 282 (63.95%) patients a percutaneous coronary intervention was performed, with stent placement. The short-term survival after ACS was detected in 383 (86.85%) patients. Conclusion: Prehospitally applied therapy stabilizes the patient's condition and expediates entrance into the haemodynamic room. A good cooperation between the prehospital and hospital level increases the chance of the short-term survival, but also of long-term quality of life of patients after ACS.