Abstract 14546: Contemporary Pre-Hospital Management of Acute Coronary Syndromes Patients: Results From the EPICOR Asia Study
Purpose: Little is known about current pre-hospital management in acute coronary syndromes (ACS) patients in Asia. In this study we describe baseline pre-hospital management patterns of ACS patients in current real-world practice in Asia.
Methods: EPICOR Asia (NCT01361386) is a prospective, multicountry, observational, real-world practice, cohort study of 12,993 consecutive patients presenting with ACS who survived to hospital discharge (51.4% STEMI, 19.9% NSTEMI & 28.8% UA). The study was designed to describe the current use of antithrombotic therapies in a broad Asia ACS population, including pre-hospital, hospital and post-discharge management. Patients were enrolled from 219 hospitals in 8 countries in Asia between 06/2011 and 04/2012.
Results: 37.4% of patients (44.2% STEMI, 36.4% NSTEMI & 25.8% UA) received pre-hospital management (either diagnostic test: ECG or medication). Drug treatment was started in 6.2% of patients before hospitalization (8.6% STEMI, 6.7% NSTEMI & 1.7% UA). Pre-hospital fibrinolysis was given in only 0.9% of STEMI patients versus 12.1% in-hospital. A small percentage of patients (6.0%) received pre-hospital anti-platelet or anticoagulant therapy (Table below). Among patients who had a pre-hospital ECG (34.9%), pre-hospital aspirin and clopidogrel were given to 15.5% & 13.5% of STEMI, to 12.4% & 9.2% of NSTEMI and to 4.1% & 2.8% of UA patients, respectively. Among patients who did not have a pre-hospital ECG (62.5%), pre-hospital aspirin and clopidogrel were given to 2.6% & 2.1% of STEMI, to 2.9% & 2.5% of NSTEMI and to 0.8% and 0.4% of UA patients, respectively. Anticoagulant was given to 4.1% of NSTEMI patients with a pre-hospital ECG.
Conclusion: Importantly, pre-hospital management among ACS patients in Asia remains infrequent. Initiation of antiplatelet agents is uncommon, even in patients who do receive pre-hospital ECG. Follow-up of these patients will help determine if these practice patterns affect outcomes.
- © 2013 by American Heart Association, Inc.