011: The major part of one-year prognosis of acute coronary syndromes is associated with the severity of the initial clinical presentation - Results from the French MONICA registries

Purpose Death rate of acute coronary syndromes has decreased for more than 50 years. Out-of-hospital mortality remains high despite improvements in acute coronary syndrome's care. Aims To evaluate the importance of out-of-hospital mortality and the main determinants of in-hospital and one-year mortality in France. Methods Analyses were based on data from the French MONICA population-based registry including exhaustively all acute coronary syndromes occurring in people aged 35–74 during the year 2006 in 3 geographic areas. First we evaluated out-of-hospital mortality. Then analyses were performed through Cox models on incident ACS reaching the hospital alive in order to determine main factors explaining the one-year mortality. Number of attributable deaths was assessed for variables of interest. Results After a one-year follow-up, case-fatality was 29.3% for incident events (n=2547) with 70.3% of out-of-hospital deaths and 21.1% occurring in the 28 days following the event. The number of attributable deaths related to 3 situations with a strong impact identified from multivariate analyses (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (59% of deaths occurring after reaching the hospital) during the one-year follow-up. These sub-groups were corresponding to patients with an important initial state of severity and not benefiting from traditionally recommended treatments. Conclusion The major part of deaths after ACS occurs in the out-of-hospital phase. Moreover, the major part of one-year mortality is associated with a very poor prognosis before medicalization. This underlines the importance of cardiovascular prevention, population education and better out-of-hospital emergency management.