Management of acute coronary syndromes in developing countries: The ACCESS registry Mohamed SOBHY (Egypt), Norka ANTEPARA (Venezuela), Alvaro ESCOBAR (Colombia), Samir ALAM (Lebanon), Alain LEIZOROVICZ (France), Carlos MARTINEZ (Mexico), José NICOLAU (Brazil), Gilles MONTALESCOT (France), on behalf of the ACCESS investigators
Funding & disclosures • The ACCESS registry is sponsored by sanofi-aventis, Paris, France
Disclosure • I have no disclosure
ACCESS: background • The burden of cardiovascular diseases is predicted to escalate in developing countries. Study aim • To investigate the descriptive epidemiology, practice patterns, and primary outcomes of patients hospitalized with an acute coronary syndrome (ACS) in countries in Latin America, the Middle East, and North and South Africa.
ACCESS: study design • Prospective, observational, multinational registry in patients hospitalized for an ACS (Jan 2007- Jan 2008). • Patients enrolled at 134 sites in 19 countries in • Latin America: Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Venezuela • Middle East: Egypt, Iran, Jordan, Kuwait, Lebanon, Saudi Arabia, United Arab Emirates • North Africa: Algeria, Morocco, Tunisia • South Africa
ACCESS: study population • Patients (age ≥21 years) admitted alive to hospital with: • ischaemic symptoms of ACS within 24 hours of presentation, and • At least 1 of the following: • ECG changes: transient ST or ST ≥1 mm, new T-wave inversion ≥1 mm, pseudonormalization of previously inverted T waves, new Q-waves, new R wave S wave in lead V1, or new left bundle branch block • documentation of coronary artery disease • Elevated troponin or CK-MB concentration • Data at baseline, discharge and at 6+ 1 mo., 12+ 1mo. Follow up.
ACCESS: endpoints12-months from hospitalization • Primary endpoint: all-cause death • Secondary endpoints: • cardiovascular death • cardiovascular death & non-fatal MI • non-fatal stroke • non-fatal MI • CV death, stroke, or MI & rehospitalization for ischaemic events • bleeding episodes
ACCESS: results • 9732 ACS patients with 1-year follow-up • Discharge diagnoses: • STEMI 45% • NSTE ACS 52% • NSTEMI 24% • Unstable angina 28%
ACCESS: reperfusion in STEMI *94% with stent; 39% with drug-eluting stent
ACCESS: death at 12 months *P<0.05 for NSTE ACS vs STEMI
ACCESS: Survival curves NSTE ACS vs STEMI P <0.0001
ACCESS: 12-month events *P ≤0.05 NSTE ACS vs STEMI †Endpoint: CV death, non-fatal stroke or MI
Main factors* associated with 12-month death (n=8788) OR (95% CI) 8.9 (6.2, 12.8) Cardiac arrest Cardiogenic shock Stroke/TIA Age >70 years 5.6 (3.9, 8.0) 3.2 (1.8, 5.7) 2.2 (1.8, 2.7) 0 2 4 6 8 10 12 14 *Four strongest independent factors among 17
ACCESS: conclusions • In this multinational, observational study of ACS patients, use of evidence-based pharmacological therapies for ACS was quite high, but reperfusion rates for STEMI (40%) were disappointingly low. • These findings suggest opportunities to reduce further the risk of long-term ischaemic events in ACS patients in developing countries.
Acknowledgements Principal Investigator:Gilles MONTALESCOT (France) Steering Committee:Norka ANTEPARA (Venezuela), Alvaro ESCOBAR (Colombia), Samir ALAM (Lebanon), Alain LEIZOROVICZ (France), Carlos MARTINEZ (Mexico), José NICOLAU (Brazil), Mohamed SOBHY (Egypt) National Coordinators:Oscar BAZZINO (Argentina), Wilson RAMIREZ (Dominican Republic), Ricarddo MARMOL (Ecuador), Ismael GUZMAN (Guatemala), Wael ALMAHMEED (UAE), Mohammed ZUBAID (Kuwait), Ashraf HAMMOUDA (Saudi Arabia), Gholamreza Davoodi (Iran), Akram AL SALEH (Jordan), Mohand HADDAK(Algeria), Abdelhamid MOUSTAGHFIR (Morocco), Rachid MECHMECH (Tunisia), Colin SCHAMROTH (South Africa) And all Study Investigatorswho participated in the ACCESS Registry
See you next year! June 2012