ABC | Volume 114, Nº6, June 2020

Special Article Barros and Silva et al. Brazilian Registry of Acute Coronary Syndromes Arq Bras Cardiol. 2020; 114(6):995-1003 Introduction The group of cardiovascular diseases, particularly acute coronary syndrome (ACS), represents the leading causeofmortality and disability in Brazil and worldwide. 1-3 In addition to its current high frequency, there is a perspective of increase in this group of diseases in developing countries, such as Brazil. 1-5 Despite the high morbidity and mortality of ACS currently, several strategies of proven efficacy to reduce the risk of complications in these patients have been developed. 6,7 However, there are flaws in evidence-based therapies when applied to ACS patients, as has been identified in previous clinical practice registries. 8-10 Those multicenter registries assessed mainly the intra-hospital period or a 30-day period from the acute event. However, they lacked long-term data on the follow-up of these patients. 8-10 Among the previous 30-day follow-up database is the partial data release (without complete sample data) of the ACCEPT study. 10 As previously reported in the 30-day follow-uppartial release, 10 the ACCEPT study group intended to continue the investigation, with the enrollment of a greater number of patients and the inclusion of 12-month follow-updata. Thus, the present analysis performed, oncemore, the assessment of the baseline characteristics and initial adherence ofmedical prescriptions to evidence-based therapies in a larger population (about twice asmany patients compared to the initial publicationwith the intermediate data) and includeddata on the incidence rateof severe clinical outcomes during the follow-up. Objectives In addition to the final results after 30 days with the overall study population, this one year follow-up assessment has the following objectives: - To assess the rate of major cardiovascular events within 12 months in a sample of Brazilian post-ACS patients; - To evaluate the conformity of medical prescriptions to evidence-based therapies within 12 months in a sample of Brazilian post-ACS patients; - To identify predictors of major cardiovascular events within 12 months in a sample of Brazilian post-ACS patients. Methods Study Design The ACCEPT (Acute Coronary Care Evaluation of Practice Registry) registry is a project conceived by the Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia - SBC), whose methods have been previously published. 10,11 In sum, it is a prospective, voluntary, multicenter study, which gathered 53 centers from the five Brazilian federal regions, with the following distribution: Southeast (50.9%), Northeast (13.2%), South (24.5%), Midwest (5.7%) andNorth (5.7%). Patient inclusion occurred from August 2010 toApril 2014, in public hospital care centers (Unified Health System - SUS), health maintenance organizations, or private health care, according with the following distribution: SUS 2669/4782 (55.8%), healthmaintenanceorganizations 1968/4782 (41.2%) and private hospitals 145/4782 (3%). Study participants Patients diagnosed with the different types of ACS were included: unstable angina (UA), acute myocardial infarction (MI) without ST-segment elevation (NSTEMI) and with ST-segment elevation (STEMI). The main inclusion criteria were: ischemic symptoms of suspected ACS associated with ischemia-like ECG changes and/ormyocardial injury biomarkers above theupper limit of normality. Patients transferred fromother institutions withmore than 12 hours after symptoms onset were excluded. Study procedures and variables analyzed The study procedures and variables analyzed in the ACCEPT study have been previously published. 10,11 In sum, data collection occurred at admission (index visit) and a second data collection was performed after 7 days or at discharge (whichever occurred first). After these two first visits, the study included visits at 30 days, 6 months and 12 months, which could take place in person, at routine medical care, or by phone. Due to the pragmatic features of the study, the identification of patients’ comorbidities (e.g.: arterial hypertension, dyslipidemia) could be performed as follows: patients’ self- assessment, use of medication (antihypertensive and lipid- lowering) or investigators’ evaluation (in the latter case, the centers were oriented to follow the recommendations on diagnosis criteria adopted by the current guidelines of the Brazilian Society of Cardiology). Physical examination data could be obtained by direct measurement (obesity was defined by BMI > 30 Kg/m²). Other criteria were based on the registry of medical records of a variable collected by interview (e.g.: stress, ex-smoker if cessation date was > 6 months). The evidence-based treatment plan that was considered in the ACCEPTwas notmodified throughout the study andwas basedon current guidelines. 6,7 This treatment plan canbe divided as follows: - Index event admission: Double antiaggregation, parenteral anticoagulant, statin and betablocker in addition to reperfusion therapy in case of STEMI. - Outpatient therapy post discharge: Double antiaggregation, statin, beta-blocker and ACE inhibitors/ARBs. The cardiovascular events of interest analyzed in the population included were: cardiovascular mortality, non-fatal cardiac arrest, reinfarction and cerebrovascular accident (CVA). 10,11 These outcomes were reported by the investigator according to recommended criteria, 10,11 without an independent adjudication committee to confirm the events. Statistical analysis The analysis of normally distributed continuous variables was performed using histograms. Normally distributed continuous variables were described as mean ± standard deviation. The means were compared between the three diagnosis groups Keywords: Acute Coronary Syndrome; Myocardial Infarction; Risk factors; Medical Records/ statistics& numeral data; Multicenter Studies 996