Thai registry in Acute Coronary Syndrome (TRACS) - An extension of Thai Acute Coronary Syndrome Registry (TACS) group: Lower in-hospital but still high mortality at one-year

Background: The Thai Registry of Acute Coronary Syndrome (TRACS) registry was conducted five years after the first Thai Acute Coronary Syndrome (ACS) registry. Objective: To describe demographics, management practices, and in-hospital outcomes of current Thai ACS patients and to seek for any significant changes in this registry from the earlier first Thai ACS registry. Material and Method: The TRACS is a multi-centers, prospective, nation-wide registration with 39 participating medical centers. Web-based data entry was used and the data were centrally managed and analyzed. Results: Between October 2007 and December 2008, 2,007 patients were enrolled. Fifty-five percent had ST elevation myocardial infarction (STEMI), 33% had non-ST-elevation myocardial infarction (NSTEMI), and 12% had unstable angina (UA). Overall prevalence of diabetes was 50.7%. The STEMI group was younger, predominantly male, with less diabetes than NSTEMI. At presentation, lower percent of cardiogenic shock (7.9%) and cardiac arrest (2.8%) were noted. Sixty seven percent of the STEMI received reperfusion therapy. Thrombolysis was given in 42.6% and primary percutaneous coronary intervention (PCI) was performed in 24.7% of all STEMI patients. Median door-to-needle and door-to-balloon time were 65 and 127 minutes. The median time-to-treatment was 285 min in the thrombolysis group and 324 min in the primary PCI group. Regarding NSTE-ACS, coronary angiography was performed in 38.4% and about one-fourth received revascularization either by PCI or bypass surgery during index admission. In-hospital mortality was 5.3% for STEMI, 5.1% for NSTEMI, and 1.7% for UA. When following the patients up to 12 months, the mortality was 14.1%, 25.0%, and 13.8% respectively. Conclusion: The TRACS registry showed differences in demographic, management practices and in-hospital outcomes of the Thai ACS patients. Although mortality rate in this registry decreased significantly as compared to the first Thai ACS registry, the results had to be interpreted with caution because of the difference in characteristics and severity of the enrolled patients. At 12-month follow-up, the mortality rate was significantly higher in NSTEMI than STEMI or UA patients. Practice management should be considered particularly for the invasive strategy for these groups of patients.