Strategies for treating acute coronary syndrome (ACS) need urgent review,
according to the authors of the prospective registry of acute ischaemic syndromes
in the UK (PRAIS-UK) trial.
The trial, which is published in the European Heart Journal (2000;21:1450) enrolled
1,046 patients presenting with either unstable angina or myocardial infarction
without ST elevation (a “minor” heart attack), who had been admitted
to 56 hospitals in the UK. Follow-up after six months showed that the rate of
death or new non-fatal MI was 12.2 per cent. This rose to 30 per cent if patients
who had refractory angina or who were readmitted with unstable angina were included.
While in hospital, 13 per cent of patients did not receive aspirin and 28 per
cent were not given heparin. At six months, 22 per cent of the patients were
not taking aspirin and 56 per cent were not on lipid-lowering therapy. The rate
of coronary angiography and revascularisation was also low at 27 and 15 per
cent, respectively.
The study was co-ordinated by Dr Marcus Flather (consultant cardiologist, Royal
Brompton hospital, London). At a press briefing on September 20, he said that
use of existing effective treatments like aspirin,
heparin, b-blockers and statins must be increased, and angiography and revascularisation
also had to be optimised. This would avoid numerous deaths, cardiac events and
hospital admissions each year in the UK. There was also a place for newer treatments,
such as the glycoprotein IIb/IIIa receptor antagonists, which further reduced
risks when added to the current recommended regimen of aspirin and heparin.
An announcement was expected shortly from the National Institute for Clinical
Excellence about the place of these drugs in the treatment of ACS.
Dr Roger Boyle (national coronary heart disease director, Department of Health)
said at the same press conference that the Government was making coronary heart
disease a top priority. Money was available to provide more smoking cessation
and rapid access chest pain clinics. Another priority was to reduce the “call
to needle” time (ie, the time from calling an ambulance to beginning thrombolysis).
The aim was that by April, 2002, 80 to 90 per cent of cardiac patients would
be discharged from hospital on aspirin, b-blockers and statins.