• Myocardial Infarction
• Cardiology Clinical Trials

Results from the ACCESS Registry identified areas in which long-term ischemic events could be reduced in patients with acute coronary syndromes (ACS) in developing countries. Mohamed Sobhy, MD, FACC, Alexandria University, Alexandria, Egypt, discussed findings from the ACCESS registry.

The ACCESS Registry was a prospective, observational, multinational registry of patients who were hospitalized for ACS from January 2007 through January 2008 that was designed to evaluate the burden of ACS and patient outcomes in developing countries. It included 134 sites within 19 developing countries in Latin America, the Middle East, North Africa, and South Africa. All patients (n=9732) were admitted within 24 hours of ischemic symptoms that were related to ACS and ECG changes, documented coronary artery disease, and/or elevated troponin/CK-MB concentration. Data were collected at baseline, discharge, 6 months postdischarge, and 12 months postdischarge. The primary endpoint was all-cause death, and secondary endpoints included cardiovascular (CV) death, CV death and nonfatal myocardial infarction (MI), nonfatal stroke, a composite of nonfatal MI, CV death, stroke, or MI, and rehospitalization for ischemic events, and bleeding episodes at 12 months postdischarge.

Fifty-two percent of the study population was diagnosed with non-ST-segment elevation (NSTE) ACS at discharge (24% NSTEMI and 28% unstable angina) compared with 45% that was diagnosed with ST-segment elevation MI (STEMI). The use of pharmacological therapies for ACS, such as aspirin, statins, β-blockers, and ACE inhibitors, was common for all study patients. Enoxaparin was used more frequently (57% for all ACS patients, NSTE ACS patients, and STEMI) than unfractionated heparin (40%, 37%, and 43%, respectively), while the use of other low-molecular-weight heparin and direct thrombin inhibitors as antithrombotic therapy was low. Coronary angiography was performed in 58% of all ACS patients, 59% of NSTE ACS patients, and 56% of STEMI patients versus percutaneous coronary intervention in 35%, 31%, and 40%, respectively. The rate of coronary artery bypass grafting was low in all groups (5.7%, 7.3%, and 3.8%, respectively). There was a low rate of reperfusion in the STEMI group (40%).

The rate of death at 12 months was highest among STEMI patients (8.4%) versus NSTE ACS (6.3%; p<0.05) and all ACS (7.3%). The most common cause of death was fatal MI (45% all ACS, 38% NSTE ACS, and 51% STEMI). The four strongest independent factors that were associated with 12-month death were cardiac arrest, cardiogenic shock, stroke/transient ischemic attack, and age >70 years. Higher rates of CV death, bleeding, and the combined composite endpoint were also observed in the STEMI group at 12 months.

These findings indicate that there is still work to be done to reduce the risk of long-term ischemic events in ACS patients in developing countries. Prof. Sobhy and colleagues were also able to identify independent factors that may predict disease mortality. These data can be used to develop solutions for ACS risk reduction in the developing world and highlight the unmet need to ease the escalating disease burden in these countries.

• © 2010 MD Conference Express