Impact of patient-related and treatment-related factors on in-hospital mortality of patients with ST-elevation myocardial infarction: Data of Russian Acute Coronary Syndrome Registry

Management of acute coronary syndrome in resource-limited set up: a summary of 4-year review of two hospitals in Ethiopia

Introduction

Acute coronary syndrome refers to a group of diseases characterized by sudden, decreased blood supply to the heart muscle that results in cell death, also known as acute myocardial infarction. This results in severe chest pain or discomfort, with the subsequent release of cardiac biomarkers, and alterations in the electrocardiogram. It can cause diminished heart function and mortality if not treated properly with suitable measures. Despite the fact that percutaneous coronary intervention is the standard of care in one subset of acute coronary syndrome, significant number of patients were treated medically due to the limited service in the setting. The purpose of this study was to look at the patterns of acute coronary syndrome (ACS), as well as the management and outcomes of these patients in two Ethiopian tertiary institutions.

Methods

A four-year retrospective study was undertaken on 308 patients with acute coronary syndrome, at two tertiary hospitals located in Ethiopia's capital-Addis Ababa.

Results and Discussion

Of the 308 patients 72.4% were male, with the average age of 56.3 ± 13.5 years. Hypertension and diabetes were the two most common risk factors identified. The average time to present to the emergency room after symptom onset was 3.7 (SD ± 3.2) days. The majority of patients (67.9%) have been diagnosed with ST- Elevated Myocardial Infarction and were classified as Killip class I. Percutaneous Coronary Intervention was performed for 12.3% of patients, with the remaining receiving medical care. The average hospital stay was 8.51 (SD ± 7.2) days while In-hospital mortality was 8.8%. Tachycardia of >140 (AOR = 7.50, 95% CI: 1.36, 41.57), any degree of left ventricular dysfunction, Killip class IV (AOR = 6.03, 95% CI: 1.27, 28.61), and non-initiation of betablockers (AOR = 0.17,95% CI: 0.05, 0.63) were significantly associated with increased in-hospital mortality.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study

BACKGROUND

Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries.

OBJECTIVE

The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia.

METHODS

A retrospective cross-sectional study was done by collecting data from patients' medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant.

RESULTS

Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality.

CONCLUSION

The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.

Outcomes Related to Antiplatelet Therapy in a High-Risk ST-Segment Elevation Myocardial Infarction Population: A Retrospective Real-World Analysis of an Italian ECMO Center

AIM

To evaluate outcomes related to antiplatelet therapy in patients with ST-elevation myocardial infarction (STEMI) admitted to the San Gerardo Hospital in Monza, an extracorporeal membrane oxygenation (ECMO) reference center in the Monza-Brianza area.

METHODS

This retrospective study enrolled patients with STEMI hospitalized between 2013 and 2017.

RESULTS

This study included 653 patients (mean age: 67.5 years, 71% male). Across the study period, ticagrelor use showed consistent increases, from 22% of patients during 2013 to 85% in 2017. Cardiac arrest prehospitalization occurred in 100 patients (15.3%), either at home (n = 85, 13.0%) or during transfer (n = 15, 2.3%); 46 patients underwent ECMO for refractory cardiac arrest. Rates of 90-day survival (hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.3-4.4, P = .004) and ST resolution (odds ratio [OR]: 2.5, 95% CI: 1.6-4.1, P = .000) were higher with ticagrelor than with other antiplatelet agents. When analyzed by each agent, patients on ticagrelor had longer survival (HR: 0.4, 95% CI: 0.2-0.8, P = .008) than patients on clopidogrel and more frequent ST resolution than those on clopidogrel or prasugrel (OR: 0.4, 95% CI: 0.2-0.7, P = .002 and OR: 0.4, 95% CI: 0.2-0.7, P = .006). There was no difference in mortality between ticagrelor and prasugrel.

CONCLUSIONS

Changes in the treatment of high-risk patients with STEMI over time are in line with changes in treatment guidelines. In these patients, ticagrelor is associated with significantly improved 90-day mortality compared with clopidogrel.

Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR)

The Russian Acute Coronary Syndrome Registry (RusACSR) is a retrospective, continuous, nationwide, Web-based registry of patients with acute coronary syndromes (ACS). The RusACSR is a database that uses a secure Web-based interface for data entry by individual users. Participation in the RusACSR is voluntary. Any clinical center that provides health care to ACS patients can take part in the RusACSR. The RusACSR enrolls ACS patients who have undergone care in Russian hospitals from February 2008 to the present. Key data elements and methods of data analysis in the RusACSR are presented in this article. Up to 2015, 213 clinical centers from 36 regions of Russia had participated in the RusACSR. Currently, the database contains data on more than 250 000 ACS patients who underwent care from 2008 to 2015. Some current problems are highlighted in this article. The RusACSR is a perspective project for different epidemiologic studies in Russian ACS patients.