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Background: A quick but thorough assessment of the patient’s history and findings on physical examination, electrocardiography, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification. This work aimed to analyze the diagnostic and prognostic tools, the modalities of management, and the hospital outcome of patients with acute coronary syndrome (ACS) at Tanta University Hospital in one year.
Methods: This ACS registry at Tanta university hospital is a prospective observational registry for 200 consecutive admitted patients with proven ACS from January 2019 to January 2020.
Results: A higher percent of hypertension, family history of ischemic heart disease and SCD, previous history of chronic kidney disease (CKD), and lower percent of a previous history of IHD in STEMI compared to NSTEMI/UA. In-hospital death, in-hospital reinfarction, and reduced ejection fraction are higher in STEMI than in NSTEMI/UA patients. (P value = 0.015, 0.018 and 0.001 respectively) without significant differences regarding in-hospital congestive heart failure (CHF) and ischemic stroke. History of CKD, higher Killip class, and in-hospital stroke were independently affecting in-hospital mortality. Also, the history of higher Killip class was independently affecting in-hospital reinfarction and in-hospital CHF. Old age and occurrence of in-hospital reinfarction were independently affecting in-hospital stroke.
Conclusion: Hypertension, diabetes, dyslipidemia, and smoking are the major risk factors for ACS so, controlling these risk factors will improve in-hospital outcomes. In STEMI, most patients underwent PPCI, which was reflected in the outcome. In NSTEMI/UA patients, both conservative and invasive management was done, taking into consideration the risk stratification of each patient, making management easier and with a good outcome.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747-57.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013;62:e147-e239.
Tegn N, Abdelnoor M, Aaberge L, Endresen K, Smith P, Aakhus S, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet. 2016;387:1057-65.
Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, et al. management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE). European heart journal. 2002;23:1177-89.
Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et al. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27:2285-93.
Negi PC, Merwaha R, Panday D, Chauhan V, Guleri R. Multicenter HP ACS Registry. Indian Heart Journal. 2016;68:118-27.
Goyal A, Chhabra L, Sciammarella JC, Cooper JS. Defibrillation; 2019.
Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited)—a prospective population-based study. Journal of the American College of Cardiology. 2013;61:1777-86.
Arnold SV, Lipska KJ, Li Y, McGuire DK, Goyal A, Spertus JA, et al. Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction. Am Heart J. 2014;168:466-70.e1.
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34:121-9.
Martinez-Sanchez C, Borrayo G, Carrillo J, Juarez U, Quintanilla J, Jerjes-Sanchez C. Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III). Arch Cardiol Mex. 2016;86:221-32.
Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation. 2010;121:750-8.
Baker TB, Collins LM, Mermelstein R, Piper ME, Schlam TR, Cook JW, et al. Enhancing the effectiveness of smoking treatment research: conceptual bases and progress. Addiction. 2016;111:107-16.
Deora S, Kumar T, Ramalingam R, Manjunath CN. Demographic and angiographic profile in premature cases of acute coronary syndrome: analysis of 820 young patients from South India. Cardiovascular diagnosis and therapy. 2016;6:193.
Montalescot G, Dallongeville J, Van Belle E, Rouanet S, Baulac C, Degrandsart A, et al. STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry). Eur Heart J. 2007;28:1409-17.
Sultana SA, Iqbal SA, Malek MA, ur Rahman MW, Alam AYMS, Haque MA, et al. A comparative study on short-term clinical outcome in acute coronary syndrome. Journal of Armed Forces Medical College, Bangladesh. 2017;13:22-7.
Ralapanawa U, Kumarasiri PVR, Jayawickreme KP, Kumarihamy P, Wijeratne Y, Ekanayake M, et al. Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC Cardiovasc Disord. 2019;19:229.
Investigators RI. Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III). Archivos de cardiología de México. 2016;86:221-32.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435-42.
Ahmad WAW, Zambahari R, Ismail O, Sinnadurai J, Rosman A, Piaw CS, et al. Malaysian national cardiovascular disease database (NCVD)–acute coronary syndrome (ACS) registry: how are we different? CVD Prevention and Control. 2011;6:81-9.
Sriha Belguith A, Beltaief K, Msolli MA, Bouida W, Abroug H, Ben Fredj M, et al. Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia). BMC Emerg Med. 2018;18:50.
Wojtkowska I, Stępińska J, Stępień-Wojno M, Sobota M, Kopaczewski J, Reszka Z, et al. Current patterns of antithrombotic and revascularisation therapy in patients hospitalised for acute coronary syndromes. Data from the Polish subset of the EPICOR study. Kardiologia Polska (Polish Heart Journal). 2017;75:445-52.
Yaghi S, Pilot M, Song C, Blum CA, Yakhkind A, Silver B, et al. Ischemic Stroke Risk after acute coronary syndrome. J Am Heart Assoc. 2016;5.