[Epidemiology of acute coronary syndromes in Italy].

Acute coronary syndromes (ACS) represent the most common cause of death in the western world and determine high morbidity. The objective of this review is to describe the epidemiology of ACS in the Italian setting, using administrative data, clinical surveys and registries. The prevalence of patients with myocardial infarction without persistent ST-segment elevation (NSTE) has increased in comparison with myocardial infarction with persistent ST-segment elevation patients. Females are about 30%, one third of patients is >75 years old, one quarter is affected by diabetes, patients with NSTE ACS show a higher risk profile. The mortality rate of patients with ACS has decreased over the last 10 years as a consequence of new therapeutic strategies. In order to offer primary coronary angioplasty to all ST-elevation myocardial infarction patients, a network between tertiary and peripheral hospitals is under development and implementation. Early experiences show a significant increase in the number of patients treated with reperfusion therapy and a decrease in mortality and morbidity. It has been demonstrated that management of NSTE patients, based on potent antithrombotic medication and coronary angioplasty, is primarily driven by resource availability rather than by clinical predictors of worse outcome. The reduction in recurrent ischemic events was obtained at the cost of an increased rate of major bleeding, which is associated with worse clinical outcomes. Therefore, it is essential the balance between the ischemic and hemorrhagic risk.