The management of patients with acute coronary syndromes (ACS) in Africa, Latin America, and the Middle East is more conservative than in Europe and the USA, although 1-year mortality is comparable. These findings from the ACCESS registry are reported in the American Heart Journal.

Between January 2007 and January 2008, 11,731 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI from 19 developing countries were prospectively enrolled in the ACCESS registry. The duration between symptom onset and hospitalization was shorter in patients with STEMI (representing 46% of all patients) than non-STEMI (4 h vs 6 h; P <0.0001).

The use of certain medical therapies compared favorably with data from Western countries; lipid-lowering drugs, aspirin, thienopyridines, and β-blockers were used in 94%, 93%, 81%, and 78% of patients, respectively. However, 39% of patients with STEMI did not receive reperfusion therapy within 24 h of admission; a rate that was much higher than in Western countries. All-cause mortality at 30 days (5.0% vs 2.4%) and 1 year (8.4% vs 6.3%) was higher for patients with STEMI than non-STEMI (P <0.0001 for both), but were similar to rates in developed countries. “Expensive drugs, such as bivalirudin and glycoprotein IIb/IIIa inhibitors are less-frequently used [in developing nations] than in the Western world, but it does not seem to have a huge impact on outcomes”, explains ACCESS investigator Gilles Montalescot. Further data are required, but these findings highlight opportunities to improve care for patients with ACS in developing countries.