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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Acute Coronary Syndrome, Adult, Aged, Cause of Death, Coronary Angiography, Female, France, Hospitalization, Humans, Incidence, Male, Middle Aged, Multivariate Analysis, Prognosis, Proportional Hazards Models, Prospective Studies, Registries, Risk Factors, Severity of Illness Index, Time Factors.
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Is the major element of 1-year prognosis in acute coronary syndromes severity of initial clinical presentation : Results from the French MONICA registries? Context: While the death rate from acute coronary syndromes (ACS) has been in decline for more than 50 years, out-of-hospital mortality remains high despite improvements in care. To evaluate the importance of out-of-hospital mortality and identify the main predictors of in-hospital and 1-year mortality in France. Analyses were based on data from the French MONICA population-based registry, which included all cases of ACS occurring in people aged 35-74 years during 2006 in three geographic areas in France. We first evaluated out-of-hospital mortality; then, using data from patients with incident ACS who reached hospital alive, Cox models were performed to determine the main predictors of 1-year mortality. The number of attributable deaths was assessed for variables of interest. After 1-year follow-up, case-fatality was 29.3% for incident events (n=2547); the proportion of out-of-hospital deaths was 70.3%, and 91.5% of deaths occurred in the 28 days following the ACS. On multivariable analysis, the number of attributable deaths associated with three scenarios (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (accounting for 59% of deaths occurring after reaching the hospital) during 1-year follow-up. These scenarios corresponded to patients with an initial severe clinical presentation in whom rates of use of specific treatments and invasive procedures were very low.
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A large proportion of fatalities after an ACS occurs in the out-of-hospital phase. Moreover, the major component of 1-year mortality is associated with a poor prognosis at initial presentation. This finding highlights the importance of cardiovascular prevention, population education and better out-of-hospital emergency management in improving prognosis after an ACS. Final Decision: yes