Background: During the year of combating cardiovascular mortality the idea of creating a total register of acute coronary syndrome for the Krasnodar Territory, which is home to more than 5.7 million people, was realized.
Purposes: organization of free and fair ACS register; definition of the demographic characteristics and medical history data of patients with ACS indicators; organization of programs to improve interaction between regional and district hospitals; assessing the continuity of the recommendations’ implementation in clinical practice; an access to monitoring and managing patients system by every doctor of the region.
Materials and methods: The basis of the register protocol, registration schemes and registration cards were taken at the ongoing federal registry of ACS. Each center established Parus registration program. Patient’s participation in the register does not affect his maintenance in the hospital and approaches to his treatment. After being discharged from the hospital patients, included in the register, are scheduled for a long observation, conducted through telephone interviews.
Results: From 11/20/15 to 20/02/16 register included 2275 patients with suspected ACS 63.8% male and 36.2% female. The mean age of included patients was 69,3 ± 3,03 years. A l-data of patients indicate that more than half of the patients had signs of heart failure, more than 1/3 – previous myocardial infarction. 64.7% were identified with obesity, 87.5% with high blood pressure, 25% with diabetes. Based on the data obtained in the register, we identified patients with non-obstructive coronary artery disease (MINOCA). 74 patients (3.2%) out of 2275. Among whom 54.2% had ACS with ST-segment elevation and 45,8% with NSTE-ACS. The mean age was 56,3±6,06 years. During the stay in the hospital 2 patients with MINOCA (1,52%) died, both with ST-segment elevation.
Conclusion: Maintaining total ACS register for the Krasnodar Territory is the first experience of total register in Russia. However, the results revealed key problems of managing of patients with ACS in the areas of Krasnodar region: big time period from the onset of symptoms to the patient’s admission to hospital; failure of previous therapy; low frequency of ticagrelor prescribing and anticoagulant medication under conservative management of MI, low loading dose of clopidogrel during the stationary phase of case management. There are no specific standards for treating patients with MINOCA so far. Patients with MINOCA appeared to be younger than patients without. Group of patients with MINOCA is dominated by those with ACS with ST-segment elevation. By identifying patients with this pathology in the total ACS register of the Krasnodar Territory, we consider it necessary to continue the study. It would be efficient to conduct patients’ monitoring at regular intervals. These facts allow us to more clearly identify the main areas of work to improve care management of patients with ACS.