Demographic, management practices and in-hospital outcomes of Thai Acute Coronary Syndrome Registry (TACSR): the difference from the Western world.

BACKGROUND To establish a national registration of acute coronary syndrome (ACS) registry in Thailand by networking health service institutions to determine the demographic, management practices, and in-hospital outcomes of patients with ACS. MATERIAL AND METHOD The Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. Institutions were invited to participate in the registry through members of the Heart Association of Thailand. A series of workshops were organized to ensure standardization and quality control of the data and conduct of the present study. Web-based double data entry was used and the data were centrally managed and analyzed. RESULTS The enrollment of the patients started in August 2002. After three years, records of 9,373 patients were collected from 17 hospitals. The patients were classified as ST elevation myocardial infarction (STEMI) (40.9.%), non-ST-elevation myocardial infarction (NSTEMI) (37.9%) and unstable angina (UA) (21.2%). The STEMI group was younger predominantly male, with a fewer number of diabetes than NSTEMI or UA. About half of the STEMI patients (52.6%) received reperfusion therapy. Primary percutaneous coronary intervention (PCI) was performed in 22.2% of STEMI. The median door to needle and door to balloon time were 85.0 and 122 minutes respectively. The median times to treatment were 240 minutes in the thrombolysis group and 359 minutes in the primary PCI group. Nearly half of NSTEMI and UA went to coronary angiography and about one-fourth of them received revascularization either PCI or coronary artery bypass grafting in the same admission. The total mortality rate was high in STEMI (17.0%) followed by NSTEMI (13.1%) and UA (3.0%). CONCLUSION Thai ACS registry provides a detail of demographic, management practices, and in-hospital outcomes of patients with ACS. Time from onset to admission, door to needle time and door to balloon time were considered as suboptimal. Overall, in-hospital mortality is higher than reports from Western countries. The raising awareness among the general population about urgency of seeking medical attention for chest pain and concerted effect to improve in-hospital time delay is warranted. These data may have an impact on our health care system and alert the government to adopt an appropriate policy to solve these problems.