Recent technological advances in the treatment of acute coronary syndrome have brought more comfort and peace of mind to patients. But have they, in the recent past, improved the lethality rate of this pathology? A study published in the Weekly Epidemiological Bulletin (BEH) shows us that this is not the case.
Interventional therapeutic practices for acute coronary syndromes (ACS) have evolved considerably since the first angioplasty performed in 1977 by Dr. Andreas Gruentzig.
A study to assess the impact of advances in coronary angioplasty on lethality
This discipline is one of the most spectacular showcases of medical progress, since it significantly reduces the duration of hospitalization as well as the means allocated to this treatment, which previously required a bypass, with its corollaries of stay in cardiac resuscitation and other long and often boring rehabilitation protocols for patients.
But the most characteristic technological advances that coronary angioplasty has known were made in the years 2000/2010. It is to evaluate the impact of these advances on the therapeutic protocols related to the disease thata French study, published in the Weekly Epidemiological Bulletin (BEH)was recently carried out, in order to compare the therapeutic management of ACS in 2016 compared to 2006 and to estimate the impact of this evolution on lethality at 1 year by calculating the preventive fraction (FP).
Slow progress in treatment and an identical lethality rate
This work concerned 2,023 patients in 2006 and 1,173 in 2016. In the acute phase, the rates of angioplasties, prescriptions of new generation antiaggregants and statins have increased in 10 years. Ischemic episodes were classified, according to ECG and laboratory findings, as STEMI, for ST+ segment elevation and positive troponins, NSTEMI, for non-ST+ and positive troponins, unstable angina, for non-ST+ and non-positive troponins and other, for equivocal or normal ST+ and troponins, as well as for unclassifiable ECGs.
After a STEMI episode, the FP of angioplasties with placement of an active stent increased, between 2006 and 2016, from 10% to 59% (+49%), and that of antiaggregants increased from 86% to 98% (+12% ). After an NSTEMI episode, the FP of angioplasties with active stent increased during the period from 19% to 45% (+26%), and that of antiaggregants from 62% to 95% (+33%). On discharge from hospital, the prescription rates, already high in 2006, have progressed little, with the exception of functional rehabilitation (+14% after a STEMI ACS). The FP of antiaggregants increased from 57% to 78% in 2016 compared to 2006, after a STEMI ACS, due to their beneficial effects on lethality.
However, the 1-year lethality remained stable, around 11%. But this work has shown a modest progression in the management of ACS in a representative sample of the French population, mainly in the acute phase of the disease.
Bruno Benque with BEH