MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado) Study. General Findings

Introduction and objectivesTo investigate the clinical characteristics and treatment of acute coronary syndromes (ACS), and to determine the effects of an early invasive strategy (EIS) in non-ST-elevation ACS (NSTEACS) and of primary percutaneous coronary intervention (PCI) in ST-elevation ACS (STEACS).MethodsData were collected prospectively for 9 months during 2004-2005 from 50 hospitals, which were randomly selected according to the level of care provided. In addition, follow-up data on mortality and readmission for ACS were collected for 6 months. The adjusted effects of different reperfusion strategies were analyzed.ResultsAfter checking data quality, the analysis included data from 32 hospitals, which covered 7923 coronary events (4431 [56%] STEACS, 3034 [38%] NSTEACS, and 458 [6%] unclassified ACS) in 7251 patients. Compared with previous studies, the use of primary PCI in STEACS had increased markedly (from 10.7% to 36.8% of patients undergoing reperfusion), as had the use of EIS in NSTEACS (from 11.1% to 19.6%). Overall in-hospital mortality was 5.7% (95% confidence interval [CI], 5.1-6.2); for STEACS it was 7.6% (95% CI, 6.7-8.7), for NSTEACS 3.9% (95% CI, 3.3-4.6), and for unclassified ACS 8.8% (95% CI, 6.2-12.2). In the population as a whole, there was no association between prognosis (ie, 6-month mortality) and EIS in NSTEACS (hazard ratio [HR]=0.94; 95% CI, 0.66-1.3) or between prognosis and primary PCI in STEACS (HR=1; 95% CI, 0.7-1.5). Findings for mortality and rehospitalization for ACS at 6 months were similar.ConclusionsData for 2004-2005 demonstrated a marked increase in the use of invasive procedures. However, the procedures employed were poorly matched to the patients' baseline risk.

Introducción y objetivosDeterminar el perfil clínico, el manejo del síndrome coronario agudo (SCA) y el efecto de la estrategia intervencionista precoz (EIP) en el SCA sin elevación del ST (SCASEST) y del intervencionismo coronario percutáneo (ICP) primario en el SCA con elevación del ST (SCACEST).MétodosInclusión prospectiva en 50 hospitales seleccionados aleatoriamente según nivel asistencial, durante 9 meses entre 2004 y 2005, y seguimiento a 6 meses de la mortalidad o el reingreso por SCA. Se analizó el efecto ajustado de las estrategias de reperfusión.ResultadosTras control de calidad, se analizaron los datos de 32 hospitales, correspondientes a 7.923 acontecimientos coronarios (4.431 SCASEST [56%], 3.034 SCACEST [38%] y 458 SCA inclasificable [6%]) de 7.251 pacientes. Respecto a registros anteriores, destaca un incremento del ICP primario en el SCACEST (del 10,7 al 36,8% de los reperfundidos) y la EIP en el SCASEST (del 11,1 al 19,6%). La mortalidad hospitalaria total fue del 5,7% (intervalo de confianza [IC] del 95%, 5,1%-6,2%); del SCACEST, el 7,6% (IC del 95%, 6,7%-8,7%); del SCASEST, el 3,9% (IC del 95%, 3,3%-4,6%), y del indeterminado, el 8,8% (IC del 95%, 6,2%-12,2%). No se observó, en el total de la población, relación con el pronóstico (mortalidad a 6 meses) de la EIP en el SCASEST (hazard ratio [HR] = 0,94; IC del 95%, 0,66-1,3) ni del ICP primario en el SCACEST (HR = 1; IC del 95%, 0,7-1,5). Se observaron resultados similares con la variable muerte o reingreso por SCA a 6 meses.ConclusionesEn 2004-2005 se registró en España un aumento de estrategias invasivas. Se observó una insuficiente adecuación de éstas al riesgo basal de los pacientes.