El estudio CRUSADE, modelo de evaluación de la calidad en la intervención coronaria percutánea

Improvement of care quality does not end with the publication of clinical trials that show clinical evidence of effectiveness or with its support by the different international therapeutic guides. This quality improvement requires evaluation in the real population. This can be done by analysis of clinical registries, that would evaluate adequate compliance of the clinical guides and their effectiveness in the real population. The CRUSADE study is a study that evaluates use, prognosis and factors of prediction, of invasive strategy by early percutaneous coronary intervention (PCI) (first 48 hours of the ischemic event) in high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Of the 17926 patients studied, 8037 (44.8%) underwent cardiac catheterism in the first 48 hours of the ischemic event. Intrahospital mortality of the invasive strategy was significantly less than medical treatment (2.5% versus 3.7%). The patients who underwent an early invasive strategy were a selected population, as the more solid independent prediction factors were associated to early invasive treatment: cardiology care, earlier age, absence of renal failure, absence of heart failure both previously or on arrival to the hospital and lower heart rate. Finally, it could be concluded that, in spite of the decrease of mortality achieved with the early invasive strategy, this would not done in most of the patients, being reserved for subgroups with lower comorbidity and for those seen by the cardiologists.