Aim. To assess the quality of medical care in the Penza region in acute coronary syndrome (ACS) clinical cases with fatal outcome up to the 24-hours of in hospital stay. Materials and methods. A local register «The daily mortality rate in ACS in the Penza region» has been developed in Penza State University and implemented in practice of all units dealing with ACS. The Register consisted of the patients who were hospitalized during 12 months of 2016—2017 years, died in the first day of their stay in the hospital and were sent to a pathoanatomical study with diagnoses: unstable angina, acute myocardial infarction (MI), acute repeated MI. The main register indicators have been filled within 24 hours from the death coming, the data of pathoanatomical research and analysis of the fatal outcome causes — within 30 days. Results. The data of 91 patients were analyzed. The average age was 76 ± 11 years, elderly people (86.8%) prevailed, two of them were older than 90 years old. The proportion of patients of working age is 13.2%. The prevalence of patients with myocardial infarction was 84 (92.3%), STEMI was registered in 54.9%, NSTEMI 9.9%, repeated MI 4.4%of cases. The average time from the disease onset to hospitalization was 17.9 (3.25) h. In 84.6% of patients there were signs of acute heart failure (class Killip ≥2) on admission, cardiogenic shock developed in 56 patients. Among patients with STEMI, only 56% of them have received thrombolytic therapy due to late presentation. 26 patients (52%) with STEMI have been treated in a hospital with availiable PCI, however, stenting has been performed in 2 patients. Protocol deviations of the medical and diagnostic measures in ACS have not been revealed. A pathological study was conducted in 78% of cases, a diagnosis discrepancies have been found in 3 cases. Conclusion. The main factors that influenced the indicator of daily mortality are the late first medical contact, that does not allow to fully use the available capabilities of pharmacoinvasive therapy, the patient age and the condition severity at the moment of first medical contact.
