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 to sample size, another marked difference is the follow-up length, because, similarly to the publication of the ACCEPT intermediate data, 10 most publications of nationwide registries on ACS only reported data on intra-hospital outcomes or at 30 day of follow-up. 12,13 The ERICO study, released in 2015, reported a one year follow-up of patients admitted due to ACS in a public hospital in the state of São Paulo. 14 Thus, the present analysis included, in an unprecedented manner, 12-month follow-up data of a large contemporary population of ACS patients from several Brazilian federal regions, including the conformity assessment of medical prescriptions to the guidelines evidence-based therapies within 12 months. The initial adherence of medical prescriptions identified in the ACCEPT study was similar to the one seen in other developing countries, 15 although it was below that of centers participating in quality programs in those same countries. 9 During the one year follow- up, there was a decrease in prescription of all therapies, especially of P2Y12 inhibitors, whose administration was far below what was observed in the international registries of developed countries. 16,17 At the 12-month follow-up, a residual risk of 13.6 per patient/year was also identified for major cardiovascular events (reinfarction, death and CVA). The connection of these events with the performance of revascularization seemedmore evident in cases of AMI, because, in unstable angina, the combined analysis of cardiovascular outcomes did not reveal a lower rate among the patients submitted to revascularization. Since this is an observational non-randomized study, such evidence does not allow for the establishment of a cause-effect relation, but it reinforces the external validity of the concept generated by clinical trials on the benefits of revascularization for ACS patients, especially for those at a higher risk. 18,19 One strategy to minimize the bias of observational studies is to include the several collected data in a model which allows to identify the individual relation in an independent manner. Among the factors identified in amultivariate analysis, twowere related to health care: public versus private and quality of therapy (complete or not). The quality of therapy was based on the evidence-based recommendations for this population. 6,7 The relation between outcome and quality of therapy has been demonstrated in several previous publications, 8,15 and showed additional importance Table 2 – Use of medication by patients with Acute Coronary Syndrome at the admission stage Medication Unstable Angina AMI without ST elevation AMI with ST elevation Total p ASA 1399/1449 (96.5%) 1580/1615 (97.8%) 1688/1713 (98.5%) 4667/4777 (97.7%) 0.001 Betablocker 1144/1449 (79%) 1323/1615 (81.9%) 1352/1713 (78.9%) 3819/4777 (79.9%) 0.052 P2Y12 inhibitor 1239/1449 (85.5%) 1483/1615 (91.8%) 1671/1713 (97.5%) 4393/4777 (92%) <0.001 Clopidogrel 1213/1449 (83.7%) 1401/1615 (86.7%) 1531/1713 (89.4%) 4145/4777 (86.8%) <0.001 Prasugrel 11/1449 (0.8%) 17/1615 (1.1%) 15/1713 (0.9%) 43/4777 (0.9%) 0.685 Ticagrelor 23/1449 (1.6%) 80/1615 (5%) 149/1713 (8.7%) 252/4777 (5.3%) <0.001 Parenteral Anticoagulant 1151/1449 (79.4%) 1468/1615 (90.9%) 1500/1713 (87.6%) 4119/4777 (86.2%) <0.001 Enoxaparina 837/1449 (57.8%) 1039/1615 (64.3%) 1086/1713 (63.4%) 2962/4777 (62%) <0.001 Fondaparinux 113/1449 (7.8%) 206/1615 (12.8%) 174/1713 (10.2%) 493/4777 (10.3%) <0.001 Unfractionated heparin 214/1449 (14.8%) 240/1615 (14.9%) 282/1713 (16.5%) 736/4777 (15.4%) 0.319 GP IIb/IIIa Inhibitors 23/1449 (1.6%) 91/1615 (5.6%) 292/1713 (17%) 406/4777 (8.5%) <0.001 Abciximab 3/1449 (0.2%) 10/1615 (0.6%) 119/1713 (6.9%) 132/4777 (2.8%) <0.001 Tirofiban 20/1449 (1.4%) 82/1615 (5.1%) 173/1713 (10.1%) 275/4777 (5.8%) <0.001 ACE inhibitor 890/1449 (61.4%) 1059/1615 (65.6%) 1263/1713 (73.7%) 3212/4777 (67.2%) <0.001 Statin 1302/1449 (89.9%) 1467/1615 (90.8%) 1576/1713 (92%) 4345/4777 (91%) 0.108 Lovastatin 0/1293 (0%) 0/1461 (0%) 1/1568 (0.1%) 1/4322 (0%) Pravastatin 40/1293 (3.1%) 44/1461 (3%) 56/1568 (3.6%) 140/4322 (3.2%) Sinvastatin 581/1293 (44.9%) 619/1461 (42.4%) 914/1568 (58.3%) 2114/4322 (48.9%) Rosuvastatin 102/1293 (7.9%) 103/1461 (7%) 60/1568 (3.8%) 265/4322 (6.1%) Atorvastatin 570/1293 (44.1%) 695/1461 (47.6%) 537/1568 (34.2%) 1802/4322 (41.7%) Dual antiplatelet therapy 1211/1449 (83.6%) 1463/1615 (90.6%) 1649/1713 (96.3%) 4323/4777 (90.5%) <0.001 Complete therapy 787/1449 (54.3%) 1062/1615 (65.8%) 1116/1713 (65.1%) 2965/4777 (62.1%) <0.001 P-value: Chi-square test. Dual antiplatelet therapy:Aspirin and P2Y12 inhibitor. Complete therapy: Dual antiplatelet therapy, ParenteralAnticoagulant, Statin and Betablocker. 999