Clinical Research in Cardiology

, Volume 107, Issue 9, pp 836–844 | Cite as

Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome

  • Héctor Bueno
  • Xavier Rossello
  • Stuart Pocock
  • Frans Van de Werf
  • Chee Tang Chin
  • Nicolas Danchin
  • Stephen W-L Lee
  • Jesús Medina
  • Ana Vega
  • Yong Huo
Original Paper



Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Methods and results

11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010–March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011–May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9–7.3%) in KS to 10.5% (8.3–12.7%) in LA.


Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.


Acute coronary syndrome Hospital discharge Mortality Regional variability 



Editorial support was provided by Carl V Felton PhD of Prime (Knutsford, Cheshire, UK), supported by AstraZeneca. Ultimate responsibility for opinions, conclusions, and data interpretation lies with the author. X.R. has received support from the SEC-CNIC CARDIOJOVEN fellowship program.


EPICOR and EPICOR Asia are funded by AstraZeneca. Being a non-interventional study, no drugs were supplied or funded.

Compliance with ethical standards

Conflict of interest

H.B. has received consulting fees from Abbott, AstraZeneca, Bayer, BMS, Novartis and Pfizer; speaking fees from AstraZeneca, Bayer, BMS-Pfizer, Ferrer, Novartis, Servier and MEDSCAPE-the; and fees for research activities from AstraZeneca, BMS, Janssen, Novartis; S.P. has received research funding from AstraZeneca. F.v.d.W. has received consulting fees and research grants from Boehringer Ingelheim and Merck, and consulting fees from Roche, Sanofi-Aventis, AstraZeneca, and The Medicines Company. C.T.C. has received research support from Eli Lilly, honoraria from Medtronic, and has been a consultant or advisory board member for AstraZeneca. N.D. has received consulting or speaking fees from AstraZeneca, BMS, Boehringer-Ingelheim, GSK, MSD-Schering Plough, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi-Aventis, Servier, Takeda, and The Medicines Company. J.M. and A.V. are employees of AstraZeneca. X.R., S.W-L.L. and Y.H. have nothing to disclose.

Supplementary material

392_2018_1254_MOESM1_ESM.docx (374 kb)
Supplementary material 1 (DOCX 373 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Héctor Bueno
    • 1
    • 2
    • 3
  • Xavier Rossello
    • 1
    • 4
    • 5
  • Stuart Pocock
    • 4
  • Frans Van de Werf
    • 6
  • Chee Tang Chin
    • 7
  • Nicolas Danchin
    • 8
  • Stephen W-L Lee
    • 9
  • Jesús Medina
    • 10
  • Ana Vega
    • 10
  • Yong Huo
    • 11
  1. 1.Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
  2. 2.Instituto de investigación i+12 and Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
  3. 3.Facultad de MedicinaUniversidad Complutense de MadridMadridSpain
  4. 4.London School of Hygiene and Tropical MedicineLondonUK
  5. 5.CIBER de enfermedades CardioVasculares (CIBERCV)MadridSpain
  6. 6.Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
  7. 7.National Heart Centre SingaporeSingaporeSingapore
  8. 8.Hôpital Européen Georges Pompidou and René Descartes UniversityParisFrance
  9. 9.Queen Mary HospitalHong Kong SARChina
  10. 10.Medical Evidence and Observational Research, Global Medical AffairsAstraZenecaMadridSpain
  11. 11.Beijing University First HospitalBeijingChina

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