Contemporary use and outcome of percutaneous coronary interventions in patients with acute coronary syndromes: Insights from the 2010 ACSIS and ACSIS-PCI surveys

Aims: In patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) is the mainstay of treatment based on current guidelines. In this paper we describe contemporary management and outcomes of patients with ACS treated by PCI in the national ACS Israeli survey (ACSIS) performed in March and April 2010. Methods and results: The ACSIS 2010 registry was conducted in all 25 hospitals in Israel and included "all comers" admitted with ACS. In-hospital and 30-day outcome was assessed. The registry included 2,193 patients with ACS. Coronary angiography was performed in 86.1% and PCI in 75.1% of cases. The mean age was 62.5 years, the transradial approach was used in 32% of patients and overall use of drug-eluting stents was 34%. Procedural complications were extremely low at less than 1%. The thirty-day mortality rate was 2.1% and the repeated myocardial infarction (MI) rate was 2.5%. The major adverse cardiac and cerebral events (MACCE) rate was 5.6%. Multivariable analysis identified age, chronic renal failure, and hyperglycaemia on admission as independent predictors of 30-day mortality for all subsets of ACS, and Killip class >I on admission and prior MI for patients with ST-elevation ACS only. Conclusions: When evidence-based medicine is applied in the treatment of patients with ACS, clinical outcome is favourable. Several clinical predictors identify high-risk patients who require special attention.