The ENACT study: a pan-European survey of acute coronary syndromes

Aim The European Network for Acute Coronary Treatment (ENACT) study was des igned to collect prospective information across Europe on the relative freq uency, diagnosis and management of the whole spectrum of acute coronary syn dromes. Methods Cardiologists, who were respondents to mailings sent out to 17 Euro pean countries with the target of reaching one centre per million inhabitan ts, completed a prospective patient record, each physician providing inform ation on 10 consecutive patients with a working diagnosis on admission of a cute coronary syndrome, and a questionnaire. Results A total of 390 responses were received (0.91/10(6) population) with data on 3092 patients in 29 countries. The patient population comprised 14 31 (46%) with an initial working diagnosis of unstable angina/non-ST-segmen t elevation myocardial infarction, 1205 (39%) with myocardial infarction an d 445 (14%) with suspected acute coronary syndrome. The ratio of unstable a ngina to myocardial infarction was 1.2:1 and this was similar across Europe . An initial diagnosis of myocardial infarction was more likely to be confi rmed than unstable angina or suspected acute coronary syndrome. There were wide variations in the rates across Europe. Most unstable angina patients r eceived aspirin, nitrates and heparin (unfractionated heparin 44% intraveno us, 16% subcutaneous; low-molecular-weight heparin 50%). Overall, 50% of un stable angina patients and 34% of myocardial infarction patients received l ow-molecular-weight heparin and 6% and 8% respectively received a glycoprot ein IIb/IIIa inhibitor, but then were large inter-country differences. Ther e were also national differences in the use of calcium antagonists, angiote nsin-converting enzyme inhibitors and bets-blockers. Conclusion The ENACT study provides robust data, for the first time, on the relative frequency of unstable angina and acute myocardial infarction acro ss Europe. It provides insight into differences in management across Europe and a reference benchmark of current treatment. (C) 2000 The European Soci ety of Cardiology.