Trends in epidemiology and the treatment of acute coronary syndromes in the Czech Republic: Comparison of the CZECH-1 and CZECH-2 registries

BackgroundThe clinical spectrum of acute coronary syndrome (ACS) has changed due to a progressively ageing population over the last two decades.AimWe analysed the changes in the epidemiological and treatment strategies between two large registries that were performed in 2005 and 2012 in well-defined populations of the Czech Republic.Methods and resultsThe CZECH-1 and CZECH-2 registries enrolled all consecutive hospitalized patients with an initial diagnosis of ACS during a 1 or 2-month period, respectively. Thirty-six and 32 hospitals participated in the CZECH-1 and CZECH-2 registries, respectively. A total of 1921 patients were enrolled in the CZECH-1 registry and 1221 patients participated in the CZECH-2 registry. Patients enrolled in the CZECH-2 registry were older than those in CZECH-1 (68 ± 12 vs. 66 ± 12 years; p < 0.001). ACS was not confirmed during hospitalization in 30.5 and 30.1% (p > 0.05) of the patients in the CZECH-1 and CZECH-2 registries, respectively. Urgent angiography in patients with ST segment elevation myocardial infarction (STEMI) was performed in 92 and 94% of the patients (p > 0.05), respectively; of these, 87 and 89% subsequently underwent primary PCI. There were no signifiant differences in in-hospital (4.2 vs. 4.4%, p=0.805) or in the mortality of patients with a final diagnosis of Q-myocardial (10.3 vs. 10.7%; p = 0.870) or non-Q-myocardial infarction (4.7 vs. 3.8%; p = 0.497) between the two registries. The estimated incidence of confirmed ACS and STEMI in a representative population from both registries was 3248 and 661 cases/million individuals/year in the CZECH-1 registry and 2149 and 652 cases/million individuals/year in the CZECH-2 registry. The fall in ACS incidence was almost exclusively due to a significant decrease in the incidence of unstable angina as the final diagnosis. At discharge, the patients with confirmed ACS were administered the following medications: aspirin (95 vs. 94%; p > 0.05), clopidogrel (60 vs. 76.4%; p < 0.001), beta-blockers (78 vs. 78%; p > 0.05), angiotensin-converting enzyme (ACE) inhibitors (50 vs. 78%; p = <0.001) and statins (75 vs. 90%; p < 0.001) in the CZECH-1 and CZECH-2 registries, respectively.ConclusionIn the Czech Republic, the age of the patients hospitalized with ACS increased between 2005 and 2012. Invasive reperfusion strategy for patients with STEMI was very high in both registries. The overall outcome in patients with confirmed ACS did not change between 2005 and 2012. The estimated incidence of ACS decreased due to the fall in unstable angina pectoris.