ArticlesTreatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data
Introduction
Ischaemic heart disease is the leading cause of death globally.1 In 2001, ischaemic heart disease accounted for 7·1 million deaths worldwide,1 5·7 million (80%) of which were in low-income countries.2, 3 Between 1990 and 2020, these diseases are expected to increase by 120% for women and 137% for men in developing countries, compared with 30–60% in developed countries.4 By 2010, 60% of the world's heart disease is expected to occur in India.5 Furthermore, South Asians have a high prevalence of risk factors, and have ischaemic heart disease at an earlier age than do people in developed countries.6, 7
Most data for patients with acute coronary syndromes are from several large registries8, 9, 10, 11, 12, 13, 14, 15, 16 with data on demography, treatments, and outcomes of patients in middle-income and high-income countries. The few studies in India are small and restricted to a few hospitals.17, 18, 19 We established a collaborative national registry of more than 20 000 patients with acute coronary syndromes (defined as myocardial infarction with ST elevation [STEMI] or non-STEMI or unstable angina). We aimed to document the characteristics, treatments, and outcomes of patients with acute coronary syndromes who were admitted to hospitals in India.
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Study participants
We established a prospective multicentre registry that recruited patients with acute coronary syndromes from 89 hospitals in 50 cities from 10 regions in India (panel 1). St John's Research Institute, in Bangalore, and the Population Health Research Institute, at McMaster University in Canada, jointly coordinated the study and managed the data.
Every centre enrolled consecutive patients who were admitted to hospital with acute coronary syndromes, and prospectively recorded data during admission
Results
During a 4-year period until 2005, 20 937 patients were enrolled. 40 teaching hospitals recruited 11 054 (54·0%) patients, and 49 non-teaching hospitals recruited 9414 (46·0%) patients. 41 of these hospitals were equipped for tertiary care (with a catheterisation lab) and 48 for secondary care; they recruited 10 790 (52·7%) and 9678 (47·3%) patients, respectively. Additional data, about patients' geographical areas, their transportation to hospitals, and their modes of payment, were collected
Discussion
We analysed data from a large registry of patients with acute coronary syndromes from India. We assessed characteristics of patients, practice patterns, and the rates of major outcomes from a range of hospitals in different regions of India. By contrast with data from developed countries, we recorded more cases of STEMI than non-STEMI or unstable angina; longer delays before admission to hospital and between admission and reperfusion therapy; and different practice patterns and outcomes.
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