Use of evidence-based interventions in acute coronary syndrome - Subanalysis of the ACCEPT registry

Abstract

Background: The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice.

Objective: To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil.

Methods: This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated.

Results: This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times.

Conclusion: This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended.

Figure 1

Drug prescription rates in acute coronary syndrome within the first 24 hours, on hospital discharge, and at 6 months. § Except ASA; * significant reduction (p < 0.05) at all three specified times; † significant reduction only at 6 months; ‡ significant increase on hospital discharge compared to the first 24 hours and significant reduction at 6 months. ASA: acetylsalicylic acid; BB: beta-blocker; ACEI: angiotensin-converting enzyme inhibitor; AC: anticoagulants; APT: antiplatelet drug (p2y12 inhibitor).

Figure 2

Drug prescription rates in acute coronary syndrome according to the clinical findings (unstable angina, NSTEMI and STEMI) on patient’s admission (24 hours). † Except ASA; * p < 0.05. ASA: acetylsalicylic acid; BB: beta-blocker; ACEI: angiotensin-converting enzyme inhibitor; AC: anticoagulants; APT: antiplatelet drug (p2y12 inhibitor); NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction.

Figure 3

Drug prescription rates in acute coronary syndrome according to the clinical findings (unstable angina, NSTEMI and STEMI) on hospital discharge. † Except ASA; * p<0.05. ASA: acetylsalicylic acid; BB: beta-blocker; ACEI: angiotensin-converting enzyme inhibitor; AC: anticoagulants; APT: antiplatelet drug (p2y12 inhibitor); NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction.

Figure 4

Drug prescription rates in acute coronary syndrome according to the presence or absence of a cardiologist on duty on patient’s admission. ASA: acetylsalicylic acid; BB: beta-blocker; ACEI: angiotensin-converting enzyme inhibitor.

Figure 5

Patients admitted with ST-segment elevation acute myocardial infarction, who met the requirements for myocardial reperfusion. pt: patients; min: minutes.