acute coronary syndrome ( acs ) represents one of the most common causes of death worldwide .
several practice guidelines have been developed in europe and north america to improve outcome of acs patients through implementation of the recommendations into clinical practice .
it is well know that there is wide gap between guidelines and implementation in real practice as was demonstrated in registry findings mainly conducted in the developed world .
a prospective observational acute coronary syndrome ( renasica ii ) registry conducted by the mexican cardiology society from december 2002 to november 2003 .
the main objective was to provide insights into risk factors and clinical characteristics , use of diagnostic resources , risk stratification , acute treatments , and hospital outcomes in patients hospitalized with acs .
patients were enrolled at 60 hospitals ( 48% public health system hospitals , 39% private hospitals , and 12% teaching hospitals from other health systems ) . almost half ( 48% ) of the hospitals were enrolled in mexico city . tertiary - care hospitals ( 35% ) with access to coronary angiography ,
percutaneous coronary angioplasty and coronary artery bypass grafting ( cabg ) enrolled 90% of the patients .
patients with characteristics of stemi on electrocardiogram ( ecg ) and who presented within 24 hours from symptoms ' onset were eligible for enrollment .
the diagnosis of stemi was confirmed by the presence of biomarkers of myocardial necrosis and characteristic evolving changes on the ecg . in - hospital
outcome was analyzed through major adverse cardiac events , including death , recurrent ischemia , acute mi , re - infarction , shock and stroke .
502 patients were excluded due to unspecified chest pain . of the remaining 8098 patients , 4555 ( 56.3% )
the most prevalent risk factors were smoking ( 66% ) , hypertension ( htn ) ( 50% ) , diabetes mellitus ( dm ) ( 43% ) , and hypercholesterolemia ( 26% ) .
a history of previous mi was present in 23% . on admission 85% of patients had typical chest pain and 74% of patients presented with killip class i. anterior mi occurred in 56% of patients and postero - inferior mi in 40% of patients .
88% of patients received aspirin during acute hospitalization , 64% angiotensin - converting enzyme inhibitors and 51% -blockers .
only 37% of patients received fibrinolytic therapy , where streptokinase was the most frequent fibrinolytic regimen used and 15% had primary pci performed .
major adverse cardiac conditions were as follows ; recurrent ischemic in 12% , re - infarction in 4% , cardiogenic shock in 4% , and stroke in 1% .
, killip class iv , high - grade av block , inferior st elevation , left bundle branch block ( lbbb ) , cardiogenic shock , stroke and re - infarction .
the renasica ii was the largest acs registry in latin america and provided important insights into risk factors , management and outcome in that part of the world .
the investigators compared their findings with previously published registries , most importantly registries from high - income countries , such as the global registry of acute cardiac events ( grace ) , the national registry of myocardial infarction ( nrmi ) , and the euro heart survey ( ehs ) 1 and 2 .
dm and smoking were overrepresented in mexican patients whereas high total cholesterol and triglycerides had a lower frequency when compared with high - income populations .
the proportion of stemi cases among acs patients , the frequencies of hypertension , male sex and 30-day death rates were comparable with those registries .
lytic therapy was the most frequently reperfusion therapy and the vast majority of patients ( 82% ) were treated with streptokinase because of its wider availability and lower cost than other fibrinolytic agents .
ischemic time delay in renasica ii was attributed to the limitations and barriers that exist in limcs for a timely first medical contact and decreasing the door - to - reperfusion period and was similar to that reported in the create ( treatment and outcomes of acute coronary syndromes in india ) and access registries .
the investigators reported several limitations of their study including ; relatively old registry ( 20022003 ) and most patients were recruited in hospitals with coronary care units from the mexico city .
we compared the findings of renasica ii to that of registries recently conducted in the middle east ; gulf race ( registry of acute cardiac events ) and gulf race ii ( see table 1 ) .
it is noteworthy that the prevalence of dm among acs in both regions ( 40% ) is probably the highest when compared to other ethnicities ( 2235% ) .
we also reported high prevalence of metabolic syndrome ( 46% ) , data on metabolic syndrome was lacking in renasica ii .
mexican acs patients were older and had higher prevalence of htn , smoking when compared to their middle - eastern counterparts .
furthermore , mexicans were more likely to present stemi , while ppci percentage use was very low in both regions when compared to reports from registries conducted in europe and north america .
findings from gulf race and gulf race-2 resulted in changing practice for stemi patients in qatar .
countrywide primary ppci ( 24 hours service ) in qatar , which was launched in october 2013 and so far it is the main modality of reperfusion therapy ( > 99% of stemi patients ) , further highlighting the importance of conducting regional registries for quality improvement .
renasica ii highlights the importance of conducting registries in various geographic locations and among different ethnicities .
these registries represent a link between randomized clinical trials , guidelines , and real clinical practice in the various communities and may help decision makers for quality improvement in the care of stemi patients .
 cardiovascular diseases are the leading cause of death , worldwide , with disproportionate representation in low- and middle - income countries ( lmics ) . the registro nacional de los sndromes coronarios agudos ii 
 ( renasica ii ) investigators reported smoking , hypertension and diabetes were the main risk factors among mexican patients presenting with st - elevation myocardial infarction ( stemi ) . 
 fibrinolytic therapy was administered to 37% . 
 primary percutaneous coronary intervention ( ppci ) was performed in only 15% of patients . 
 30-day mortality was 10% . 
 this study highlights the importance of conducting regional registries for quality improvement . 
Introduction
The study
Results
Discussion
What we have learned?