Background

We aimed to analyze the 2020 standard of care in certified German chest pain units (CPU) with a special focus on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) through a voluntary survey obtained from all certified units, using a prespecified questionnaire.

Methods

The assessment included the collection of information on diagnostic protocols, risk assessment, management and treatment strategies in suspected NSTE-ACS, the timing of invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI), and the choice of antiplatelet therapy.

Results

The response rate was 75%. Among all CPUs, 77% are currently using the European Society of Cardiology (ESC) 0/3‑h high-sensitive troponin protocol, and only 20% use the ESC 0/1‑h high-sensitive troponin protocol as a default strategy. Conventional ergometry is still the commonly performed stress test with a utilization rate of 47%. Among NSTEMI patients, coronary angiography is planned within 24 h in 96% of all CPUs, irrespective of the day of the week. Prasugrel is the P2Y12 inhibitor of choice in ST-segment elevation myocardial infarction (STEMI), but despite the impact of the ISAR-REACT 5 trial on selection of antiplatelet therapy, ticagrelor is still favored over prasugrel in NSTE-ACS. If triple therapy is used in NSTE-ACS with atrial fibrillation, it is maintained up to 4 weeks in 51% of these patients.

Conclusion

This survey provides evidence that Germany’s certified CPUs ensure a high level of guideline adherence and quality of care. The survey also identified areas in need of improvement such as the high utilization rate of stress electrocardiogram (ECG).

中文翻译：

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德国认证胸痛科室临床实践模式调查

背景

我们的目的是通过对所有认证单位进行自愿调查，使用预先指定的标准，分析 2020 年经过认证的德国胸痛单位 (CPU) 的护理标准，特别关注非 ST 段抬高急性冠脉综合征 (NSTE-ACS)。调查问卷。

方法

评估包括收集疑似 NSTE-ACS 的诊断方案、风险评估、管理和治疗策略、非 ST 段抬高型心肌梗死 (NSTEMI) 侵入性治疗的时机以及抗血小板治疗的选择等信息。

结果

回应率为75%。在所有 CPU 中，77% 目前使用欧洲心脏病学会 (ESC) 0/3‑h 高敏感肌钙蛋白协议，只有 20% 使用 ESC 0/1‑h 高敏感肌钙蛋白协议作为默认策略。传统测力法仍然是常用的压力测试，使用率为 47%。在 NSTEMI 患者中，96% 的 CPU 计划在 24 小时内进行冠状动脉造影，无论星期几。普拉格雷是 ST 段抬高型心肌梗死 (STEMI) 的首选 P2Y12 抑制剂，但尽管 ISAR-REACT 5 试验对抗血小板治疗的选择产生了影响，但在 NSTE-ACS 中，替格瑞洛仍然优于普拉格雷。如果在伴有心房颤动的 NSTE-ACS 中使用三联疗法，则 51% 的患者可维持长达 4 周。

结论

这项调查提供的证据表明，德国经过认证的 CPU 可确保高水平的指南遵守和护理质量。调查还发现了需要改进的领域，例如负荷心电图（ECG）的高利用率。