Skip to main content
SpringerLink
Log in

Guideline-adherent therapy in patients with acute coronary syndromes

The EPICOR registry in Germany

Leitliniengerechte Therapie von Patienten mit akutem Koronarsyndrom

Das EPICOR-Register in Deutschland

  • Original article
  • Published:
Herz Aims and scope Submit manuscript

Abstract

Background

Representative data on the current management of patients with acute coronary syndromes (ACS) are of high interest. The EPICOR registry aimed to prospectively collect such real-life data with particular focus on antithrombotic drug utilization and outcomes.

Methods

As part of the international prospective EPICOR registry, 29 hospitals in Germany documented 296 patients with ST-elevation myocardial infarction (STEMI)-ACS and 333 with unstable angina or non-STEMI (NSTEMI)-ACS surviving the hospital phase. The statistical analysis was performed in a descriptive manner. The ClinicalTrials.gov identifier is NCT01171404.

Results

The mean age of patients was 62 ± 13 years, and 77.4 % were men. Treatment with antithrombotic agents was initiated in the prehospital phase in 50.7 % of STEMI and 33.3 % of NSTEMI patients. During the hospital stay (median 7.0 days), cardiac catheterization was performed in 97.6 %, percutaneous coronary intervention in 85.6 %, thrombolysis in 4.6 %, and coronary bypass surgery in 2.7 % patients. The use of acetylic salicylic acid (ASA) was reported in 95.6 % vs. 96.1 %, clopidogrel in 60.8 % vs. 73.0 %, prasugrel in 45.6 % vs. 22.5 %, any GP IIb/IIIa inhibitor in 52.4 % vs. 18.9 % [any dual combination of ASA+(clopidogrel/prasugrel)in 94.0 vs. 91.0 %], statins in 94.6 % vs. 92.2 %, beta blockers in 96.3 % vs. 94.6 %, and ACE-I/ARB in 91.6 % vs. 87.7 % of STEMI vs. NSTEMI patients, respectively. Combined use of the five drug classes recommended in the guidelines—ASA, P2Y12 antagonists, statin, beta blocker, and ACE-I/ARB—was reported in 81.1 % vs. 69.4 % of STEMI vs. NSTEMI patients, respectively.

Conclusion

In Germany a high proportion of patients with ACS are treated according to current guidelines, receiving primary revascularization as well as antithrombotic drugs and other agents for prevention of secondary events; associated bleeding complications were less frequent as compared with published registries.

Zusammenfassung

Hintergrund

Repräsentative Daten bezüglich der aktuellen Behandlung von Patienten mit akutem Koronarsyndrom („acute coronary syndrom“, ACS) sind von größtem Interesse. Das EPICOR-Register hat das Ziel, prospektive Real-life-Daten zu sammeln, mit besonderem Fokus auf die Verwendung antithrombotischer Medikamente und Outcomes.

Methoden

Als Teil des internationalen prospektiven EPICOR-Registers haben 29 Kliniken in Deutschland 296 Patienten mit STEMI-ACS und 333 Patienten mit instabiler Angina pectoris oder NSTEMI-ACS dokumentiert, die die Krankenhausphase überlebten. Die statistische Analyse erfolgte deskriptiv. Die ClinicalTrials.gov Registriernummer ist NCT01171404.

Ergebnisse

Das Durchschnittsalter der Patienten betrug 62 ± 13 Jahre, 77,4 % waren Männer. Die Behandlung mit antithrombotischen Medikamenten wurde bei 50,7 % der STEMI- und bei 33,3 % der NSTEMI-Patienten in der prähospitalen Phase begonnen. Während des Krankenhausaufenthalts (Median: 7,0 Tage) wurde in 97,6 % der Fälle eine kardiale Katheterisierung, in 85,6 % eine perkutane koronare Intervention, in 4,6 % eine Thrombolyse und in 2,7 % eine Bypassoperation durchgeführt. Bei STEMI vs. NSTEMI wurde über die Anwendung von Acetylsalicylsäure (ASS) in 95,6 % vs. 96,1 % der Fälle berichtet, von Clopidogrel in 60,8 % vs. 73,0 %, von Prasugrel in 45,6 % vs. 22,5 %, von einem GP-IIb/IIIa-Inhibitor in 52,4 % vs. 18,9 % [eine beliebige Kombination von ASS + (Clopidogrel/Prasugrel) in 94,0 % vs. 91,0 %], von Statinen in 94,6 vs. 92,2 %, von β-Blockern in 96,3 % vs. 94,6 % und von ACE-I/ARB in 91,6 % vs. 87,7 % der Fälle. Über eine kombinierte Anwendung der 5 in den Leitlinien empfohlenen Medikamentenklassen ASS, P2Y12-Antagonisten, Statine, β-Blocker und ACE-I/ARB wurde bei 81,1 % vs. 69,4 % der Patienten berichtet.

Schlussfolgerung

In Deutschland wird ein großer Teil der Patienten mit ACS gemäß den aktuellen Leitlinien behandelt, indem sie eine primäre Revaskularisation sowie antithrombotische Medikamente und andere Arzneimittel zur Prävention sekundärer Ereignisse erhalten. Blutungskomplikationen traten im Vergleich zu veröffentlichten Registern weniger häufig auf.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Statistisches Bundesamt Deutschland Ten leading causes of mortality 2012 in Germany (Todesursachen: Sterbefälle insgesamt 2012 nach den 10 häufigsten Todesursachen der International Statistical Classification of Diseases and Related Health Problems (ICD-10)). https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Todesursachen/Tabellen/SterbefaelleInsgesamt.html. Accessed 25 Aug 2014

  2. Hamm CW, Bassand JP, Agewall S et al (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054

    Article  PubMed  Google Scholar 

  3. Thygesen K, Alpert JS, Jaffe AS et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33(20):2551–2567

    Article  PubMed  Google Scholar 

  4. Steg PG, James SK, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619

    Article  CAS  PubMed  Google Scholar 

  5. Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31(20):2501–2555

    Article  PubMed  Google Scholar 

  6. Brieger D (2012) Antithrombotic strategies to reduce adverse clinical outcomes in patients with acute coronary syndrome. Am J Cardiol 110(8):1200–1206

    Article  CAS  PubMed  Google Scholar 

  7. Eggers KM, Kempf T, Venge P et al (2010) Improving long-term risk prediction in patients with acute chest pain: the Global Registry of Acute Coronary Events (GRACE) risk score is enhanced by selected nonnecrosis biomarkers. Am Heart J 160(1):88–94

    Article  PubMed  Google Scholar 

  8. Goodman SG, Huang W, Yan AT et al (2009) The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Am Heart J 158(2):193–201 e191–195

    Article  PubMed  Google Scholar 

  9. Lewis WR, Peterson ED, Cannon CP et al (2008) An organized approach to improvement in guideline adherence for acute myocardial infarction: results with the get with the guidelines quality improvement program. Arch Intern Med 168(16):1813–1819

    Article  PubMed Central  PubMed  Google Scholar 

  10. Yan AT, Yan RT, Huynh T et al (2009) Understanding physicians’ risk stratification of acute coronary syndromes: insights from the Canadian ACS 2 Registry. Arch Intern Med 169(4):372–378

    Article  PubMed  Google Scholar 

  11. Hanssen M, Cottin Y, Khalife K et al (2012) French registry on acute ST-elevation and non ST-elevation myocardial infarction 2010. FAST-MI 2010. Heart 98(9):699–705

    Article  PubMed Central  PubMed  Google Scholar 

  12. Sciahbasi A, Rizzello V, Gonzini L et al (2014) Chronic aspirin and statin therapy in patients with impaired renal function and acute coronary syndromes: results from the IN-ACS outcome registry. Eur J Prev Cardiol 21(2):214–221

    Article  PubMed  Google Scholar 

  13. Stauffer JC, Goy JJ, Duvoisin N et al (2012) Dramatic effect of early clopidogrel administration in reducing mortality and MACE rates in ACS patients. Data from the Swiss registry AMIS-Plus. Swiss Med Wkly 142:w13573

    PubMed  Google Scholar 

  14. Kirchberger I, Meisinger C, Heier M et al (2011) Patient-reported symptoms in acute myocardial infarction: differences related to ST-segment elevation: the MONICA/KORA myocardial infarction registry. J Intern Med 270(1):58–64

    Article  CAS  PubMed  Google Scholar 

  15. Hailer B, Naber C, Koslowski B et al (2011) Gender-related differences in patients with ST-elevation myocardial infarction: results from the registry study of the ST elevation myocardial infarction network Essen. Clin Cardiol 34(5):294–301

    Article  PubMed  Google Scholar 

  16. Ndrepepa G, Mehilli J, Schulz S et al (2009) Patterns of presentation and outcomes of patients with acute coronary syndromes. Cardiology 113(3):198–206

    Article  PubMed  Google Scholar 

  17. Bauer T, Hoffmann R, Junger C et al (2009) Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice. Clin Res Cardiol 98(3):171–178

    Article  PubMed  Google Scholar 

  18. Schwarz AK, Zahn R, Hochadel M et al (2011) Age-related differences in antithrombotic therapy, success rate and in-hospital mortality in patients undergoing percutaneous coronary intervention: results of the quality control registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Clin Res Cardiol 100(9):773–780

    Article  CAS  PubMed  Google Scholar 

  19. Bueno H, Danchin N, Tafalla M et al (2013) EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) study: rationale, design, and baseline characteristics. Am Heart J 165(1):8–14

    Article  PubMed  Google Scholar 

  20. Lim MJ, Eagle KA, Gore JM et al (2005) Treating patients with acute coronary syndromes with aggressive antiplatelet therapy (from the Global Registry of Acute Coronary Events). Am J Cardiol 96(7):917–921

    Article  PubMed  Google Scholar 

  21. Mathews R, Peterson ED, Chen AY et al (2011) In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care: derivation and validation of a model from the ACTION Registry(R)-GWTG. Am J Cardiol 107(8):1136–1143

    Article  PubMed  Google Scholar 

  22. Doyle BJ, Ting HH, Bell MR et al (2008) Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv 1(2):202–209

    Article  PubMed  Google Scholar 

  23. Birkemeyer R, Rillig A, Koch A et al (2010) Primary angioplasty for any patient with ST-elevation myocardial infarction? Guideline-adherent feasibility and impact on mortality in a rural infarction network. Clin Res Cardiol 99(12):833–840

    Article  PubMed  Google Scholar 

  24. Delgado-Rodriguez M, Llorca J (2004) Bias. J Epidemiol Community Health 58(8):635–641

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The study was financially supported by Astra Zeneca.

Compliance with ethical guidelines

Conflict of interest. U. Zeymer, H. Heuer, P. Schwimmbeck, S. Genth-Zotz, K. Wolff, and C.A. Nienaber state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Author information

Authors and Affiliations

  1. Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany

    U. Zeymer MD, FESC

  2. Institut für Herzinfarktforschung, Ludwigshafen, Germany

    U. Zeymer MD, FESC

  3. Klinik für Innere Medizin I, St. Johannes-Hospital gGmbH, Dortmund, Germany

    H. Heuer

  4. Klinik für Kardiologie, Klinikum Leverkusen, Leverkusen, Germany

    P. Schwimmbeck

  5. Klinik für Innere Medizin I, Katholisches Klinikum Mainz, Mainz, Germany

    S. Genth-Zotz

  6. Medizinische Abteilung, AstraZeneca GmbH, Wedel, Germany

    K. Wolff

  7. Universitäres Herzzentrum Rostock, Universitätsmedizin Rostock, Rostock, Germany

    C.A. Nienaber

Authors
  1. U. Zeymer MD, FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Heuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Schwimmbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Genth-Zotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C.A. Nienaber
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The EPICOR Investigators

Corresponding author

Correspondence to U. Zeymer MD, FESC.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zeymer, U., Heuer, H., Schwimmbeck, P. et al. Guideline-adherent therapy in patients with acute coronary syndromes. Herz 40 (Suppl 1), 27–35 (2015). https://doi.org/10.1007/s00059-014-4161-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-014-4161-7

Keywords

Schlüsselwörter

Search

Navigation