[The CRUSADE study, evaluation model of quality in percutaneous coronary intervention]. / El estudio Crusade, modelo de evaluación de la calidad en la intervención coronaria percutánea.

Improvement of care quality does not end with the publication of clinical trials that show clinical evidence of effectiveness or with its support by the different international therapeutic guides. This quality improvement requires evaluation in the real population. This can be done by analysis of clinical registries, that would evaluate adequate compliance of the clinical guides and their effectiveness in the real population. The CRUSADE study is a study that evaluates use, prognosis and factors of prediction, of invasive strategy by early percutaneous coronary intervention (PCI) (first 48 hours of the ischemic event) in high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Of the 17,926 patients studied, 8037 (44.8%) underwent cardiac catheterism in the first 48 hours of the ischemic event. Intrahospital mortality of the invasive strategy was significantly less than medical treatment (2.5% versus 3.7%). The patients who underwent an early invasive strategy were a selected population, as the more solid independent prediction factors were associated to early invasive treatment: cardiology care, earlier age, absence of renal failure, absence of heart failure both previously or on arrival to the hospital and lower heart rate. Finally, it could be concluded that, in spite of the decrease of mortality achieved with the early invasive strategy, this would not done in most of the patients, being reserved for subgroups with lower comorbidity and for those seen by the cardiologists.

El estudio Crusade, modelo de evaluación de la calidad en la intervención coronaria percutánea / The Crusade study, evaluation model of quality in percutaneous coronary intervention

La mejora de la calidad asistencial no finaliza con la publicación de ensayos clínicos que demuestran evidencia clínica de efectividad, ni por su respaldo por las distintas guías terapéuticas internacionales. Esta mejora de la calidad requiere una evaluación en la población real, ello se puede realizar mediante el análisis de registros clínicos, que valorarían el adecuado cumplimiento de las guías clínicas y su efectividad en la población real. El estudio CRUSADE es un estudio que evalúa la utilización, el pronóstico y los factores de predicción de la estrategia invasiva mediante la intervención coronaria percutánea (ICP) precoz (primeras 48 horas del evento isquémico), en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) de alto riesgo. De los 17.926 pacientes estudiados, a 8.037 (44,8%) se les realiza cateterismo cardíaco en las primeras 48 horas del evento isquémico. La mortalidad intrahospitalaria de la estrategia invasiva fue significativamente menor que el tratamiento médico (2,5% frente a 3,7%). Los pacientes a los que se les realizó una estrategia invasiva precoz representaban una población seleccionada, al ser los factores independientes de predicción más sólidos, asociados al tratamiento invasivo precoz: la asistencia cardiológica, la edad más joven, la ausencia de insuficiencia renal, ausencia de insuficiencia cardíaca previa, o a la llegada al hospital y una frecuencia cardíaca más baja. Pudiéndose concluir finalmente, que a pesar de la disminución de la mortalidad conseguida con la estrategia invasiva precoz, ésta no se realiza en la mayoría de los pacientes, quedando reservada para subgrupos de menor comorbilidad, y para aquellos atendidos por los cardiólogos

Improvement of care quality does not end with the publication of clinical trials that show clinical evidence of effectiveness or with its support by the different international therapeutic guides. This quality improvement requires evaluation in the real population. This can be done by analysis of clinical registries, that would evaluate adequate compliance of the clinical guides and their effectiveness in the real population. The CRUSADE study is a study that evaluates use, prognosis and factors of prediction, of invasive strategy by early percutaneous coronary intervention (PCI) (first 48 hours of the ischemic event) in high-risk patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Of the 17926 patients studied, 8037 (44.8%) underwent cardiac catheterism in the first 48 hours of the ischemic event. Intrahospital mortality of the invasive strategy was significantly less than medical treatment (2.5% versus 3.7%). The patients who underwent an early invasive strategy were a selected population, as the more solid independent prediction factors were associated to early invasive treatment: cardiology care, earlier age, absence of renal failure, absence of heart failure both previously or on arrival to the hospital and lower heart rate. Finally, it could be concluded that, in spite of the decrease of mortality achieved with the early invasive strategy, this would not done in most of the patients, being reserved for subgroups with lower comorbidity and for those seen by the cardiologists