Stakeholder Insight: Acute Coronary Syndromes Fresh Look at Acs in Europe

What Is The Real Picture?

Publication Date	December 2007
Publisher	Datamonitor
Product Type	Report
Pages	164
ISBN Number	not applicable
Product Code	DAT09511

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Summary

Introduction

The face of ACS is changing. The ageing population and pressure of growing risk factors have made a significant impact on the management strategies in ACS. This report unveils the true picture through in-depth analysis of data on over 21,000 ACS patient records in the 5 major European pharmaceutical markets (5EU; France, Germany, Italy, Spain and the UK).

Scope

What are the current definitions, diagnostic methods and treatment approaches of the disease?
To what extent are reperfusion therapies, such as PCI (percutaneous coronary intervention) and/or thrombolysis, used?
What is the current role of pre-hospital thrombolysis and how is this likely to change in the future?
What are the current hospital admission and logistics issues?

Highlights

Costs are no longer the restraining or dominant driver of a specific pharmacological strategy. Datamonitor's findings show that the routine use of troponins as cardiac markers has aided this development, with almost 90% of all ACS patients receiving tests for either troponin I or troponin T across the 5EU.

A new definition for myocardial infarction has shifted a significant number of patients from unclear diagnosis of unstable angina to myocardial infarction moving from an essentially conservative and observational approach to an increase in more aggressive treatment strategies.

Advances in novel imaging techniques provide opportunities to diagnose and treat the most complex ACS cases, however, inter-hospital logistics, necessary specialist training and cost constraints continue to prevent hospitals and clinicians from regular use of those diagnostic methods.

Reasons to Purchase

Understand current definitions, diagnostic methods and treatment approaches in ACS
Quantify current dynamics of hospital logistics, conservative therapies and reperfusion therapies, such as PCI and thrombolysis
Unveil the in-depth influencing factors leading to selection of specific pharmacological and interventional strategies

Content

About Datamonitor Healthcare
- About The Cardiovascular Analysis Team
Chapter 1 Executive Summary
- Scope of The Analysis
- Datamonitor Insight Into The Acs Market
- Contributing Experts
Chapter 2 Acs Definitions And Pathophysiology
- Acute Coronary Syndromes
- Definitions
- Pathophysiology
- Coronary Artery Disease And Atherosclerosis
- Vulnerable Plaque
- Histopathology of Atherosclerotic Lesions
- Remodeling And Role of Coronary Artery Inflammation
- Thrombosis
- Atherosclerotic Calcification
- Ischemia
- Unstable Angina (Ua)
- Variant Angina
- Non-St Segment Elevated Myocardial Infarction (Nstemi)
- Non-St Segment Elevated Myocardial Infarction (Nstemi) And St Segment Elevated Myocardial Infarction (Stemi)
- New Definition of Myocardial Infarction
Chapter 3 Epidemiology
- Acs Epidemiology Specifics And Limitations
- Ageing Population
- Male To Female Ratio And Age
- Risk Factors
- Smoking
- Obesity And Overweight Prevalence
- Diabetes
- Hypertension
- Dyslipidemia
- Prevalence And Incidence of Acs In The 5eu
- Incidence of Stemi
- Incidence of Ua And Nstemi
Chapter 4 Diagnosis And Investigation In Acs
- Symptoms
- Initial And Final Diagnosis
- Physical Examination And Chest Pain Differential
- Clinical Tests In Primary Investigation
Ecg And Ecg Stress Testing
- Cardiac Biomarkers
- Cardiac Troponins
- Creatine Kinase (Ck)
- Myoglobin
- C-Reactive Protein (Crp)
- Neurohormonal Activation Markers
- Novel Biomarkers
- Multimarker Approach
- Risk Stratification
- Role of Imaging Tests In Acs
- Invasive Imaging Testing
- Coronary Angiography
- Intravascular Ultrasound (Ivus)
- Intravascular Mri (Ivmri)
- Non-Invasive Imaging Testing
- Echocardiography And Stress Echo
- Chest X-Ray
- Nuclear Perfusion Tests
- Role of Mri And Ct In Coronary Heart Disease Diagnosis
- Limitations of Early Imaging In The Emergency Department
Chapter 5 Pharmacological Strategies
- Drug Classes In Acs
- Anti-Ischemic Agents
- Nitrates
- Betablockers
- Calcium Channel Blockers
- Ace Inhibitors And Angiotensin Ii Receptor Blockers
- Antithrombotics
- Anticoagulants
- Heparins
- Antiplatelet Agents
- Cox-1 Inhibitors (Aspirin)
- Adp Receptor Antagonists
Gpiib/Iiia Receptor Inhibitors
- Thrombolytics
- Fibrinolysis
- Pharmacological Reperfusion
- Statins
Chapter 6 Revascularization Strategies
- Coronary Thrombolysis
- Pre-Hospital Thrombolysis
- In-Hospital Thrombolysis
- Contraindications To Fibrinolytic Therapy
- Interventions Versus Thrombolysis
- Clinical Trial Evidence: C-Port And A Meta-Analysis
- Evidence From Registries
- Angioplasty
- Stenting
- In-Stent Restenosis: The Man-Made Condition
- Drug-Eluting Stents
Esc Guidelines On Pci Strategy In Nste-Acs And Stemi
- Coronary Artery Bypass Graft (Cabg)
Chapter 7 Hospital Infrastructure And Patient Flow
- Overview
- General Practitioners And Outpatient Facilities
- Role of Ambulance Services
- Emergency Department (Ed)
- Coronary Care And Intensive Care Unit
- Cardiac Catheterization Laboratory (Cathlab)
Chapter 8 Review of Current Guidelines
- Esc Guidelines
- Recommendations By The Esc
- Guidelines For Stemi Patients
Chapter 9 Key Figures And Statistical Analysis
- Methodology
- Patient Demographics
- Main Diagnosis
- Acs Age And Sex Distributions
- Co-Morbidities And Risk Factors
- Diabetes
- Dyslipidemia
- Hypertension
- Obesity
- Smoking
- Acs Hospital Logistics
- Mode of Admission
- Mode of Admission For Patients With St-Segment Elevation
- Type of Hospital For Acs Patient Admission.
- The Importance of Cathlabs
- Point of Entry To Hospital
- First Stage
- Second Stage
- Length of Stay In Hospital
- Hospital Transfers
- Diagnostic Procedures
- Cardiac Biomarkers
- Non-Invasive Imaging Test
- Reperfusion Therapy
- Thrombolytic Therapy
- Coronary Interventions
- Pharmacological Therapy
- Anticoagulants
- Unfractionated Heparins
- Low Molecular Weight Heparins
- Antiplatelet Agents
- Cox-1 Inhibitors
- Adp Receptor Antagonists
Gpiib/Iiia Receptor Inhibitors
- Anti-Ischemic Agents
- Nitrates
- Betablockers
- Ace Inhibitors
- Summary
Appendix
- References
- General Sources
- Obesity Epidemiology Sources
- France
- Germany
- Italy
- Spain
- Uk
- About Datamonitor
- About Datamonitor Healthcare
- About The Cardiovascular Disease Analysis Team
- Disclaimer
List of Tables
- Table 1: Prevalence of Obesity In The Seven Major Markets (000s), 2006-2015
- Table 2: Prevalence of Obesity / Overweight In The Seven Major Markets (000s), 2006-2015
- Table 3: Estimated Absolute Prevalence of Diabetes In The Seven Major Markets (Millions), 2006
- Table 4: Prevalence of Hypertension In The Seven Major Markets (000s), 2003
- Table 5: Estimated Prevalent Persons With Dyslipidemia Across The Seven Major Markets, 2005
- Table 6: Incidence of St-Segment Elevation Myocardial Infarction (000s)
- Table 7: Incidence of Unstable Angina And Non-St Segment Elevation Myocardial Infarction (000s)
- Table 8: Types of Chest Pain
- Table 9: Risk Stratification Summary For Acs, 2006
- Table 10: Number of Pci Procedures Performed In The 5eu, 2005
- Table 11: Cabg Procedures Performed In The 5eu, 2005
- Table 12: Esc Guidelines For The Management of Stemi, 2002
List of Figures
- Figure 1: Development And Progression of Atherosclerosis
- Figure 2: Pathogenesis of A Plaque Leading To Rupture
- Figure 3: Acs Pathophysiology Cycle
- Figure 4: The 10 Leading Causes of Death In High-Income Countries (%),2005 Projections
- Figure 5: Deaths Attributed To Specific Cardiovascular Diseases, 2006
- Figure 6: Major Causes of Death In The 5eu, 2006
- Figure 7: Distribution of The Population In Europe By Age, 2004
- Figure 8: Distribution of The Population In Europe By Age, 2050
- Figure 9: Basic Diagnostic Flow In Acs
- Figure 10: Antiplatelet Therapy In Acs
- Figure 11: Ancrod Acts Indirectly On The Thrombolytic Pathways
- Figure 12: Contraindications To Fibrinolytic Therapy
- Figure 13: Pci Procedures Carried Out By Indication In The 5eu, 2005
- Figure 14: Management of Acs Without St-Elevation (Nste-Acs)
- Figure 15: Management of Acs In Stemi
- Figure 16: Typical Patient Flow In Case of Acute Chest Pain
- Figure 17: Delays In Patients With Acute Chest Pain
- Figure 18: Proportion of Patients Presented With And Without St-Segment Elevation On Initial Ecg, 5eu, 2007
- Figure 19: Ratio of Main Acs Diagnoses In 5eu
- Figure 20: Overall Acs Age Distribution In The Acv Analyzer Sample
- Figure 21: Acs Age Distribution Split By Country And Sex
- Figure 22: Changes In Main Diagnosis Ratio In Age Distribution
- Figure 23: Changes In Main Diagnosis Ratio By Age And Sex, Male
- Figure 24: Changes In Main Diagnosis Ratio By Age And Sex, Female
- Figure 25: Age-Related Variations In Male:Female Ratio of Acs Patients In The 5eu
- Figure 26: Diabetes Distribution Among Acs Patients In The 5eu
- Figure 27: Dyslipidemia Distribution Among Acs Patients In The 5eu
- Figure 28: Hypertension Distribution Among Acs Patients In The 5eu
- Figure 29: Bmi Distribution Among Acs Patients In The 5eu
- Figure 30: Percentage of Patients Who Smoke In The Acs Analyzer Sample Per Country
- Figure 31: Hospital Admission Mode For Acs Patients
- Figure 32: Mode of Hospital Admission For Patients With St-Segment Elevation
- Figure 33: Patients Admitted Via Ambulance To Hospitals With Or Without Cathlabs - All Patients Versus Those With St-Segment Elevation
- Figure 34: Proportion of Acs Patients Admitted To Hospitals With Or Without Cathlab By All Modes of Admission - All Patients Versus Those With St-Segment Elevation
- Figure 35: First Stop In Hospital After Admission - All Patients Versus Those With St-Segment Elevation
- Figure 36: Second Stop In Hospital After Admission - All Patients Versus Those With St-Segment Elevation
- Figure 37: Diagnostic Challenge: Second Stop In Hospital After Admission For Patients Without St-Segment Elevation And With Negative Troponin
- Figure 38: Length of In-Hospital Stay For Acs Patients, Ua
- Figure 39: Length of In-Hospital Stay For Acs Patients, Nstemi
- Figure 40: Length of In-Hospital Stay For Acs Patients, Stemi
- Figure 41: Percentage of All Acs Patients Who Have Been Transferred Or Referred To Hospitals And Transferred From Hospitals For Further Pci Or Cabg Or Other Treatment
- Figure 42: Distribution of Troponin Test
- Figure 43: Distribution of Echo And Nuclear Perfusion Tests
- Figure 44: Distribution of Ct And Mri Tests
- Figure 45: Distribution of Stress Test
- Figure 46: Distribution of Ivus (%) In Angiography Cases Only
- Figure 47: Distribution of Thrombolytic Therapy In All Acs Patients And In Patients Presented With St-Segment Elevation
- Figure 48: Country Distribution of Thrombolytic Therapy In Patients Presented With St-Segment Elevation Only
- Figure 49: Country Distribution of Success Rate of Thrombolytic Therapy In Patients Presented With St-Segment Elevation
- Figure 50: Specific Thrombolytic Molecules Use Distribution In 5 European Countries
- Figure 51: % of All Acs Patients Receiving Diagnostic Angiography Test Then Pci And Then Stenting
- Figure 52: Door To Pci Time, Percentage of Patients Who Received Pci <12h From Hospital Admission Vs. >12h From Hospital Admission
- Figure 53: Distribution of Stent Implantations By Type
- Figure 54: % of Cabg
- Figure 55: Early Reperfusion Therapy (< 12 H After Onset of Symptoms) Distribution In Stemi Patients
- Figure 56: Use of Unfractionated Heparins In The Treatment of Acs Patients
- Figure 57: Use of Low Molecular Weight Heparins (Lmwh) In The Treatment of Acs Patients
- Figure 58: Use of Cox-1 Inhibitors (Aspirin) In The Treatment of Acs Patients
- Figure 59: Use of Adp Receptor Antagonists In The Treatment of Acs Patients
- Figure 60: Use of Gpiib/Iiia Receptor Inhibitors In The Treatment of Acs Patients
- Figure 61: Use of Nitrates In The Treatment of Acs Patients
- Figure 62: Use of Betablockers In The Treatment of Acs Patients
- Figure 63: Use of Ace Inhibitors In The Treatment of Acs Patients