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The change that is happening in the world concerning the management of ACS, is focusing on the speed of service, i.e DTB, DTN, FMC etc. The data provided in the guidelines are from developed countries. Our study focused on the evolution of the standards of care in Egypt representing the Middle East and north Africa.
To delineate the evolution in the characteristics, treatments, and outcomes of patients with (ACS), by comparing current registry with those of previous local registries.
The study was performed in the National Heart Institute and Kasr Einy hospitals, including a total of 1807 ACS patients. 606 patients were collected prospectively (G3) and compared with 1201 patients collected retrospectively from previous national registries performed in the NHI from 2007(G1) and 2010 (G2). Data of all patients included: History taking, clinical examination, ECG, echo, reperfusion modality adjunctive medical treatment and whether coronary angiography+/- PCI was done or not; outcome and in hospital mortality.
The percentage of STEMI increased among those presenting with ACS. (from 59% in G1 vs. 63% in G2 to almost 74% in G3)P<0.001. The mean ages were 54.5 +/- 11.8 G1, 56.9 +/- 10.6 in G2, and 54.3 +/- 10.9 in G3. Significant drop in mean age occurred G2 vs. G3 (P=0.001). Gender distribution hasn’t change significantly. Smoking and diabetes increased with no statistical significance. Patients with previous PCI increased significantly 5% in G1 5.6% in G2 reaching 12% in G3 (P=0.001). Coronary Angiography increased from 40 % in G1 to 52% in G3(P<0.001) . PCI was done to 48.3 % of admitted patients of G3 vs. 22% in G2 (P<0.001) and 26% in G1(P<0.001). Primary PCI has increased significantly 12.36% G1(P=0.001), 13% G2(P=0.001) , and almost 40% G3. Door to needle (DTN) and door to balloon (DTB) showed no statistical difference. DTN 20 +/- 8 min G1 vs 21.5 +/- 7.3 minutes (P=0.105), while DTB 102 +/- 10.9 min G1 vs. 101.5 +/- 26.6 min (P=0.86). Overall complications have decreased significantly. Mortality has improved, 4.24% G1 vs. 2.5% in G3 (P=0.044).
Mean age, smoking, hypertension, and diabetes haven’t change significantly over many years. This finding necessitates the formulation of programs to increase patients’ awareness, and also secondary prevention of CAD. The intervention strategies have seen huge flourishment. The percentage of PCI increased significantly, but still thrombolysis is the primary reperfusion modality. That shows the need for developing our insurance system to cover a broader spectrum with more services.