Short-term outcome and attainment of secondary prevention goals in patients with acute coronary syndrome--results from the countrywide TARGET study.

BACKGROUND/OBJECTIVES: Acute coronary syndromes (ACS) continue to pose a significant medical and socioeconomic burden worldwide. Optimal management strategy aims to improve short and long-term outcome. The present study aims to assess short-term outcome of real-world ACS patients and evaluate the achievement rate of secondary prevention goals. METHODS: The TARGET study is an observational study enrolling 418 consecutive ACS patients from 17 centers countrywide (78.0% males, 63.9 ± 12.9 years). After the in-hospital phase, patients were followed for 6 months. In total, 366 patients were included in the prospective phase of the study. At the end of the follow-up, mortality, major adverse cardiovascular events (MACE), prescription pattern of cardiovascular medications, lipid levels, adherence rate to treatment and behavioral recommendations were measured. RESULTS: The overall mortality was 4.8% and the rate of MACE was 17.5%. At 6 months, a significantly lower proportion of patients received antiplatelet agents and statins as compared to hospital discharge. At the end of the follow-up, 87.7% of patients remained on statin treatment, yet only 18.2% of patients had LDL cholesterol levels less than 70 mg/dL. The adherence pattern to lifestyle and dietary recommendations remained low (66.2% quit smoking, 55.8% and 81.3% followed physical activity and dietary recommendations respectively). CONCLUSION: Despite the low rate of mortality and MACE occurrence rate in this countrywide observational study, the attainment rate of secondary prevention goals is relatively poor. Improvement interventions focusing in these gaps of optimal care provision are expected to have a favorable impact on the prognosis of real world ACS patients.

Influence of mitral regurgitation on left atrial thrombus and spontaneous echocardiographic contrast in patients with rheumatic mitral valve disease.

The aim of this study was to investigate the influence of mitral regurgitation (MR) on left atrial (LA) thrombus formation and spontaneous echocardiographic contrast in patients with rheumatic mitral valve disease. LA thrombus and spontaneous contrast are considered risk factors for embolic complications. The presence of MR has been related to a low incidence of embolization; however, its effect on thrombus formation and spontaneous contrast has not been clarified. We studied by transesophageal echocardiography 55 patients with rheumatic mitral valve disease, who were receiving anticoagulant treatment. Atrial thrombus was detected in 13 patients who had a lower incidence of significant MR (p < 0.03), a smaller regurgitant jet (p < 0.02), and a higher incidence of atrial fibrillation (p < 0.05) than the rest of the group. Spontaneous contrast was detected in 34 patients with larger atria (p < 0.006), smaller regurgitant jets (p < 0.05), a smaller mitral valve area (p < 0.008), and a higher incidence of atrial fibrillation (p < 0.002) than the rest of the group. Patients without significant MR are at high risk for LA thrombus formation and subsequent embolization and represent a subgroup in whom careful anticoagulation is needed. Conversely, the presence of significant MR correlates with a lower incidence of spontaneous contrast, thrombi, and embolization.