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The Romanian National Registry of non-ST Elevation Acute Coronary Syndromes – Design and Rationale
Introduction: Non-ST segment elevation acute coronary syndromes (NSTE-ACS) form a large part of the number of annual emergency admissions in the Cardiology Departments in Romania, representing a significant burden on the health care system resources. The European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of NSTE-ACS patients represent ideal standards, which are difficult to implement, given the significant differences in the socio-economic climates of the various European Union countries, as the access to modern reperfusion techniques for NSTE-ACS patients, including Romania, is usually suboptimal.
Objectives: The evaluate the current implementation state of the ESC recommended protocols for the diagnosis and treatment of NSTE-ACS patients in Romania. There are no data regarding the number of patients who benefit from modern revascularization techniques, the time intervals between symptom onset, positive diagnosis and revascularization procedures, and the impact of these strategies on in-hospital and one-year mortality.
Materials and methods: We support the development of an online National Registry of NSTE-ACS patients, in which data obtained from the in-hospital medical records of patients undergoing invasive management will be prospectively recorded. The platform will initially be accessible to 11 interventional centers, and will include patients diagnosed and treated according to local protocols. Patient status at one year after the acute event will also be recorded. The Registry will eventually be accessible to any center in Romania caring for NSTE-ACS patients. The recorded variables will be based on those with a significant impact on the time from symptom onset to the positive diagnosis, type of clinical presentation, appropriate treatment initiation and the type of applied treatment.
Expected outcomes: Local clinical expertise, the number of treated patients and center-level technical barriers are expected to significantly influence the reported diagnostic and therapeutic measures. The performance of the various local in-hospital guidelines and transfer protocols between non-interventional and interventional centers will be analyzed, based on which recommendations and objectives can be defined in order to optimize the ESC guidelines implementation.
Conclusion: The National Registry of non-ST elevation acute coronary syndromes will provide an essential tool that facilitates the implementation of optimal ESC guideline-driven diagnostic and treatment measures, by adapting its recommendations to the socio-economic status in Romania and ensuring the best possible outcomes for the NSTE-ACS patient.
Keywords: ischemic heart disease, non-ST elevation acute coronary syndromes, unstable angina, myocardial infarction, registry, Romania