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Alfaddagh A, Khraishah H, Romeo GR, Kassab MB, McMillan Z, Chandra-Strobos N, Blumenthal R, Albaghdadi M. Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India. Glob Heart 2024; 19:37. [PMID: 38681971 PMCID: PMC11049669 DOI: 10.5334/gh.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Abstract
Background Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). Methods We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Conclusion Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. Clinical Trial registration ClinicalTrials.gov Unique identifier: NCT02256658.
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Affiliation(s)
- Abdulhamied Alfaddagh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Giulio R. Romeo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, US
| | - Mohamad B. Kassab
- Cardiovascular research center, Massachusetts General Hospital, Boston, MA, US
| | - Zeb McMillan
- Department of Anesthesiology, Division of Critical Care, UC San Diego, San Diego, CA, USA
| | - Nisha Chandra-Strobos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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Harikrishnan S, Rath PC, Bang V, McDonagh T, Ogola E, Silva H, Rajbanshi BG, Pathirana A, Ng GA, Biga C, Lüscher TF, Daggubati R, Adivi S, Roy D, Banerjee PS, Das MK. Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023. Indian Heart J 2024:S0019-4832(24)00057-9. [PMID: 38609052 DOI: 10.1016/j.ihj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.
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Affiliation(s)
| | - Prathap Chandra Rath
- Apollo Health City, Jubilee Hills, Hyderabad, President, Cardiological Society of India (CSI), India
| | - Vijay Bang
- Lilavati Hospital, Bandra West, Mumbai, Immediate Past-President, CSI, India
| | | | - Elijah Ogola
- University of Nairobi (Kenya), President Pan African Society of Cardiology, Kenya
| | - Hugo Silva
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Treasurer, Argentinian Cardiac Society, Argentina
| | - Bijoy G Rajbanshi
- Nepal Mediciti, Lalitpur, Past-President, Cardiac Society of Nepal, Nepal
| | - Anidu Pathirana
- National Hospital of SriLanka, Past-President SriLanka Heart Association, Sri Lanka
| | - G Andre Ng
- University of Leicester, President-Elect, British Cardiovascular Society, United Kingdom
| | - Cathleen Biga
- President and CEO of Cardiovascular Management of Illinois, Vice President, American College of Cardiology, USA
| | - Thomas F Lüscher
- Royal Brompton Hospital Imperial College London, London, President-Elect European Society of Cardiology, United Kingdom
| | - Ramesh Daggubati
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shirley Adivi
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Debabrata Roy
- Rabindranath Tagore Institute of Cardiac Sciences, Kolkata, Hon. General Secretary, CSI, India
| | - P S Banerjee
- Manipal Hospital, Kolkata, Past-President, CSI, India
| | - M K Das
- B.M. Birla Heart Research Centre, Kolkata, Past-President CSI, India
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Gupta MD, Batra V, Muduli S, Mp G, Kunal S, Bansal A, Gautam A, Malhotra RK, Goyal D, Qamar A, Yusuf J. Epidemiological profile and clinical outcomes of very young (<35 years) and young (35-50 years) patients with STEMI: Insights from the NORIN STEMI registry. Indian Heart J 2024; 76:128-132. [PMID: 38574813 PMCID: PMC11143511 DOI: 10.1016/j.ihj.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite significant progress in primary prevention, rates of myocardial infarction (MI) in South Asian population is alarmingly high. OBJECTIVES We sought to compare risk factor profiles and outcomes between individuals with ST-Segment Elevation Myocardial Infarction (STEMI) in young (<50 years) and old (≥50 years) age groups. METHODS North India STEMI Registry (NORIN-STEMI) is a prospective observational registry of patients hospitalised with STEMI. We conducted a study of young patients (<50 years) regarding their risk factors for coronary artery disease (CAD), in-hospital and 30-day mortality and compared with their older counterpart. RESULTS Among 5335 patients enrolled, 1752 (32.8%) were young and were 19 years younger than the older cohort. Major risk factors in young patients were physical inactivity (75.1%) and alcohol intake (67.8%). Higher prevalence of tobacco use (66.6% vs 52.4%), but lower prevalence of diabetes (16% vs 26.3%) and hypertension (18.5% vs 29.9%) were seen in young STEMI. Young patients were less likely to die both in-hospital (5.9% vs 10.0%) and at 30-days (11.1% vs 16.2%). Left ventricular ejection fraction (LVEF) < 30% at admission [OR: 8.00, 95% confidence interval (CI): 4.60-13.90, P < 0.001 in-hospital, OR: 3.92, 95% CI: 2.69-5.73 at 30-days] and female sex were strongest predictors of mortality. CONCLUSIONS Young STEMI patients constituted one-third of total cohort. Most of them were tobacco consumers with lesser prevalence of diabetes and hypertension. They were less likely to die both in-hospital and at 30 days because of earlier presentation to a health care facility and hence a relatively preserved LVEF.
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Affiliation(s)
- Mohit D Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Subrat Muduli
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Girish Mp
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Shekhar Kunal
- Department of Cardiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ankur Gautam
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Rajeev Kumar Malhotra
- Delhi Cancer Registry, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Dixit Goyal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Arman Qamar
- Section of Interventional Cardiology, Northshore University Health System, Evanston, IL, USA
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
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Bora S, Adole PS, Vinod KV, Pillai AA, Ahmed S. The genetic polymorphisms and activity of glyoxalase 1 as a risk factor for acute coronary syndrome in South Indians with type 2 diabetes mellitus. Gene 2023; 885:147701. [PMID: 37572800 DOI: 10.1016/j.gene.2023.147701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE The individuals' genetic traits predispose them to a higher or lower risk of Type 2 diabetes mellitus (T2DM) and its complications, for example, acute coronary syndrome (ACS). As carbonyl stress is responsible for the pathogenesis and complications of T2DM, and glyoxalase 1 (GLO1) is the most crucial determinant of carbonyl stress, the study aimed to explore the association between GLO1 gene polymorphism, GLO1 activity in red blood cell (RBC), plasma methylglyoxal (MG) levels, and ACS risk in South Indian T2DM patients. METHODS A total of 150 T2DM patients with ACS as cases and 150 T2DM patients without ACS as controls were recruited in a case-control study. The rs4746, rs1049346 and rs1130534 of the GLO1 gene were analysed using TaqMan allele discrimination assay. The RBC GLO1 activity and plasma MG levels were measured. RESULTS Significantly lower RBC GLO1 activity and higher plasma MG levels were found in cases compared to controls (p < 0.001 and p = 0.008, respectively). The genotype and allele frequencies of rs1049346 significantly differed between cases and controls (p < 0.001). For rs1130534 and rs1049346, no significant difference was found. For rs1049346, the TT and CC genotypes were associated with higher (p = 0.002) and lower (p = 0.001) ACS risk, respectively, in various genetic models. The TT genotype of rs1049346 was associated with lower RBC GLO1 activity (p = 0.004) and higher MG level (p = 0.010). In haplotype analysis, higher ACS susceptibility with the TAT haplotype (p < 0.001) and lower ACS susceptibility with the TAC haplotype (p < 0.001) were observed. Also, lower RBC GLO1 activity was associated with the TAT haplotype (p = 0.002). CONCLUSIONS The rs1049346 of the GLO1 gene may be associated with ACS risk in South Indian T2DM patients, and the T and C allele might be essential precipitating and protective factors, respectively.
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Affiliation(s)
- Sushmita Bora
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Prashant Shankarrao Adole
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
| | - Kolar Vishwanath Vinod
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Shaheer Ahmed
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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Narayanan S, Joseph S, Varghese AC, Nair RG, Mohan H, Edger D, Sudhakar A. Plaque morphology and distribution in patients with and without myocardial bridge - an intravascular ultrasound study. Acta Cardiol 2023; 78:894-900. [PMID: 36939314 DOI: 10.1080/00015385.2023.2187117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina, acute coronary syndromes (ACS) and sudden cardiac death. Acceleration of atherosclerosis in proximal vessel is reported in patients with MB, while bridged segments are reported to be free of atherosclerosis. METHODS We assessed patients who underwent intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) of left anterior descending (LAD) artery. Plaque characteristics derived from IVUS analysis were compared between those who displayed myocardial bridge versus those who did not harbour the anomaly. RESULTS One hundred and forty-seven (147) patients underwent IVUS guided PCI. Incidence of MB was 44/147 (29.9%). Mean age of patients who had MB {+} was higher (62.1 ± 10.3 vs. 57.8 ± 11.2 (p = .03). 142/147 (96.6%) patients presented with ACS. ST elevation myocardial infarction (STEMI) was the most common presenting diagnosis (110/147 to 74.8%). There were no differences in qualitative plaque characteristics - attenuated plaque, calcification or calcium score between two groups. Plaque burden and length of the lesion in the proximal vessel were not different. Among patients with MB {+}, atheromatous extension to segments underlying the bridge was seen in 31/44 (70.5%) cases. CONCLUSIONS In a series of patients who presented with advanced clinical atherosclerosis, plaque characteristics were not different in patients who harboured myocardial bridge vs. those who did not have the anomaly. Atheromatous involvement was seen extending into bridged segment contrary to previous reports.
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Affiliation(s)
- Sajan Narayanan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Stigi Joseph
- Little Flower Hospital & Research Institute, Angamaly, India
| | | | | | - Hareesh Mohan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Denim Edger
- Little Flower Hospital & Research Institute, Angamaly, India
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Ndaba L, Mutyaba A, Mpanya D, Tsabedze N. In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa. J Cardiovasc Dev Dis 2023; 10:348. [PMID: 37623361 PMCID: PMC10455389 DOI: 10.3390/jcdd10080348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5-8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04-0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
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Affiliation(s)
| | | | | | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (L.N.); (A.M.); (D.M.)
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Kebede B, Getachew M, Agegnew S, Dagnew EM, Abebe D, Belayneh A, Tegegne BA, Kebede T, Kiflu M, Biyazin Y, Alamneh YM. Acute coronary syndrome and its treatment outcomes in Ethiopia: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 16:98. [PMID: 37550741 PMCID: PMC10408155 DOI: 10.1186/s40545-023-00603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is the principal cause of death in developing countries including Ethiopia. No study reports the overall patterns of risk factors and burden of in-hospital mortality in Ethiopia. This study, therefore, aimed to assess the magnitude of risk factors, management, and in-hospital mortality of ACS in Ethiopia. METHODS Electronic searching of articles was conducted using PubMed, Science Direct, EMBASE, Scopus, Hinari, and Google Scholar to access articles conducted in Ethiopia. The Preferred Reporting Items for Systematic Reviews checklist was used for identification, eligibility screening, and selection of articles. Data were extracted with an abstraction form prepared with Microsoft Excel and exported to STATA for analysis. Funnel plot, Begg's test, and Egger's test were used to determine publication bias. Heterogeneity between the studies was checked by I2 statistic. The pooled prevalence of risk factors and in-hospital mortality of ACS were estimated using a random-effects meta-analysis model. RESULTS Most (59.367%) of the patients had ST-segment elevation myocardial infarction (STEMI). Hypertension (54.814%) was the leading risk factor for ACS followed by diabetes mellitus (38.549%). Aspirin (56.903%) and clopidogrel (55.266%) were most frequently used in patients with STEMI ACS, respectively. The pooled proportion of in-hospital mortality of ACS was 14.82% which was higher in patients with STEMI (16.116%). CONCLUSION The rate of in-hospital mortality is still high which was higher in patients with STEMI. Initiation of treatment must consider the heterogeneity of each patient's risk factor and reperfusion therapy should be implemented in our setting.
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Affiliation(s)
- Bekalu Kebede
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Melese Getachew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia.
| | - Samuel Agegnew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Ephrem Mebratu Dagnew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Anteneh Belayneh
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Bantayehu Addis Tegegne
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Tiringo Kebede
- Department of Nursing, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Mekides Kiflu
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health Nursing, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Krishnan A, Asadullah M, Kumar R, Amarchand R, Bhatia R, Roy A. Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 15:100222. [PMID: 37614354 PMCID: PMC10442961 DOI: 10.1016/j.lansea.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 08/25/2023]
Abstract
Background Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies including stroke. We assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India and identified the reasons and determinants of this delay. Methods We conducted a social audit among all civil-registered premature (30-69 years) deaths due to acute cardiac event or stroke in the district. The three-delays model was used to qualitatively classify the delays in care-seeking-deciding to seek care, reaching the appropriate health facility (AHF) and initiating definitive treatment. Based on the estimated time from symptom onset to reaching AHF, we classified patients as early (reached within one hour) or delayed arrivers. We used mixed-effect logistic regression with postal code as a random effect to identify determinants of delayed arrival. Findings Only 10.8% of the deceased reached an AHF within one hour. We noted level-1 delay in 38.4% (60% due to non-recognition of seriousness); level-2 delay in 20% (40% due to going to an inappropriate facility) and level-3 delay in 10.8% (57% due to lack of affordability). Patients with a monthly family income of >270US$ (aOR 0.44; 95% CI 0.21-0.93) were less and those staying farther from AHF (aOR 1.12; 95% CI 1.01-1.25 for each Km) were more likely to have delayed arrival in AHF. Interpretation A small proportion of patients with cardiac and stroke emergencies reach health facility early with delays at multiple levels. Addressing the reasons for delay could prevent these deaths. Funding : Indian Council of Medical Research, New Delhi, India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Md Asadullah
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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10
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Yoon HJ. A Big Call to Action: Improving STEMI Management in Low-and Middle-Income Countries. JACC. ASIA 2023; 3:443-445. [PMID: 37396419 PMCID: PMC10308149 DOI: 10.1016/j.jacasi.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Hyuck-Jun Yoon
- Address for correspondence: Dr Hyuck-Jun Yoon, Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine, 42601, Dalgubeol-daero 1035, Dalseo-gu, Daegu, South Korea.
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Qamar A, Bhatia K, Arora S, Hendrickson M, Gupta P, Fatima A, MP G, Bansal A, Batra V, Ricciardi MJ, Grines CL, Yusuf J, Mukhopadhyay S, Smith SC, Tyagi S, Bhatt DL, Gulati M, Gupta MD. Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI: Findings From the NORIN-STEMI Registry. JACC. ASIA 2023; 3:431-442. [PMID: 37396424 PMCID: PMC10308105 DOI: 10.1016/j.jacasi.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 07/04/2023]
Abstract
Background Low- and middle-income countries account for most of the global burden of coronary artery disease. There is a paucity of data regarding epidemiology and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in these regions. Objectives The authors studied the contemporary characteristics, practice patterns, outcomes, and sex differences in patients with STEMI in India. Methods NORIN-STEMI (North India ST-Segment Elevation Myocardial Infarction Registry) is an investigator-initiated prospective cohort study of patients presenting with STEMI at tertiary medical centers in North India. Results Of 3,635 participants, 16% were female patients, one-third were <50 years of age, 53% had a history of smoking, 29% hypertension, and 24% diabetes. The median time from symptom onset to coronary angiography was 71 hours; the majority (93%) presented first to a non-percutaneous coronary intervention (PCI)-capable facility. Almost all received aspirin, statin, P2Y12 inhibitors, and heparin on presentation; 66% were treated with PCI (98% femoral access) and 13% received fibrinolytics. The left ventricular ejection fraction was <40% in 46% of patients. The 30-day and 1-year mortality rates were 9% and 11%, respectively. Compared with male patients, female patients were less likely to receive PCI (62% vs 73%; P < 0.0001) and had a more than 2-fold greater 1-year mortality (22% vs 9%; adjusted HR: 2.1; 95% CI: 1.7-2.7; P < 0.001). Conclusions In this contemporary registry of patients with STEMI in India, female patients were less likely to receive PCI after STEMI and had a higher 1-year mortality compared with male patients. These findings have important public health implications, and further efforts are required to reduce these gaps.
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Affiliation(s)
- Arman Qamar
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Hendrickson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Puneet Gupta
- Department of Cardiology, Janakpuri Superspeciality Hospital, New Delhi, India
| | - Amber Fatima
- Division of Cardiology, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, Illinois, USA
| | - Girish MP
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ankit Bansal
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vishal Batra
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Mark J. Ricciardi
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Cindy L. Grines
- Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | - Jamal Yusuf
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sanjay Tyagi
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Mohit D. Gupta
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Hussain MM, Baharuddin KA, Fauzi MH, Abu Bakar MA, Ziyan A, Ahmed AZ, Sunil M. Factors associated with prehospital delay in acute myocardial infarction in Maldives. Int J Emerg Med 2023; 16:31. [PMID: 37122000 PMCID: PMC10149151 DOI: 10.1186/s12245-023-00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is the top cause of death in Maldives. Our study aims to determine the prehospital delay and its associated factors in AMI patients in Maldives. METHODS A cross-sectional study was conducted with 127 patients, divided into early (≤ 6 h) and delayed (> 6 h) presenters to the hospital. The data collection for the study was carried out by interviewing AMI patients, focusing on their socio-demographic characteristics, coronary artery disease risk factors, clinical symptoms, situational factors, and behavioral and cognitive responses to symptoms. RESULTS The median onset-to-door time was 230 (IQR 420) minutes. The mean age of AMI patients was 50.9 (SD ± 12.9) years old, and 39.4% of them had delayed presentation to the hospital. Smokers (adj OR = 0.3; 95% CI: 0.1, 0.9; P = 0.047) and those with previous episodes of chest pain or AMI (adj OR = 0.2; 95% CI: 0.03, 0.91; P = 0.038) were significant factors for early presentation to the hospital, while denial of symptoms (adj OR = 29.3; 95% CI: 1.6, 547.2; P = 0.024) and lack of knowledge (adj OR = 7.2; 95% CI: 1.77, 29.43; P = 0.006) led to a delayed decision to seek treatment. Situational factors such as onset at the workplace (adj OR = 5.8; 95% CI: 1.24, 26.83; P = 0.025) had lower odds of delay, whereas referral cases (adj OR = 7.7; 95% CI: 1.9, 30.94; P = 0.004) and use of sea ambulance (adj OR = 11.1; 95% CI: 2.8, 43.8; P = 0.001) were prone to delay in presentation to the hospital. CONCLUSION Sea ambulance, referral cases, lack of knowledge, and denial of symptoms are significant factors associated with prehospital delay among patients with AMI. Public awareness about the benefits of early presentation and improvement of the means of transportation between islands is suggested to improve emergency cardiac care in the country.
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Affiliation(s)
- Madheeh Mohamed Hussain
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Kamarul Aryffin Baharuddin
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Hashairi Fauzi
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Mimi Azliha Abu Bakar
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ahmed Ziyan
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Aminath Zeyba Ahmed
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Mohamed Sunil
- National Cardiac Centre, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
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Ray S, Shivdasani B, Mohan JC, Shah VT, Hiremath J, Karnik R, Desai B, Madan H, Garg R, Christopher J. Clinical Decision Pathway for the Use of Fondaparinux in the Management of Acute Coronary Syndrome (ACS) in Hospitals with and Without Catheter Laboratories: An Expert Opinion from India. Cardiol Ther 2023; 12:261-274. [PMID: 37043080 DOI: 10.1007/s40119-023-00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
The current recommendations by Indian experts who are focused on the challenges in the management of patients with acute coronary syndrome (ACS) in rural areas, due to limited catheterization (CATH) lab facilities and interventional cardiologist coverage across the country, are described. 120 cardiologist experts drafted recommendations during ten advisory board meetings conducted from April to May 2022. Experts framed statements based on experience, collective clinical judgment from practical experience, and available scientific evidence regarding ACS. The consensus positioned fondaparinux as highly useful in non-CATH-lab-based hospitals for patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS) and ST elevation acute coronary syndrome (STE-ACS) patients who cannot be shifted to percutaneous coronary intervention (PCI)-capable centres, or for patients who are thrombolysed at peripheral centres.
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Affiliation(s)
| | | | | | - V T Shah
- Dr. V T Shah Diagnostic Centre & Clinic, Mumbai, 8595513162, India
| | | | | | | | - Hemant Madan
- Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - Rajeev Garg
- Aware Gleneagles Global Hospitals, Hyderabad, India
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14
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Wu C, Li L, Wang S, Zeng J, Yang J, Xu H, Zhao Y, Wang Y, Li W, Jin C, Gao X, Yang Y, Qiao S. Fibrinolytic therapy use for ST-segment elevation myocardial infarction and long-term outcomes in China: 2-year results from the China Acute Myocardial Infarction Registry. BMC Cardiovasc Disord 2023; 23:103. [PMID: 36814182 PMCID: PMC9948459 DOI: 10.1186/s12872-023-03105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Data on fibrinolytic therapy use for ST-segment elevation myocardial infarction (STEMI) and long-term clinical outcomes in developing countries are limited. We aimed to investigate the management and 2-year mortality of fibrinolytic-treated patients in China. METHODS A total of 19,112 patients with STEMI from 108 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. We investigated the 2-year all-cause mortality among patients treated with fibrinolysis. Non-invasive clinical indexes were used to diagnose successful fibrinolysis or not. RESULTS Only 1823 patients (9.5%) enrolled in the registry underwent fibrinolysis and 679 (37.2%) could be treated within 3 h after symptom onset. The overall use of rescue percutaneous coronary intervention was 8.9%. Successful fibrinolysis, which could be achieved in 1428 patients (78.3%), was related to types of fibrinolytic agents, symptom to needle time, infarction site, and Killip class. Follow-up data were available for 1745 patients (95.7%). After multivariate adjustment, successful fibrinolysis was strongly associated with a decreased risk of death compared with failed fibrinolysis at 2 years (8.5% vs. 29.0%, hazard ratio: 0.27, 95% confidence interval: 0.20-0.35). CONCLUSION Within a minority of STEMI patients in the CAMI registry underwent fibrinolysis, most of them could achieve successful clinical reperfusion, presenting a much benign 2-year survival outcome than those with failed fibrinolysis. Quality improvement initiatives focusing on fibrinolysis are warranted to achieve its promise fully. TRIAL REGISTRATION URL: https// www. CLINICALTRIALS gov . Unique identifier: NCT01874691. Registered 11/06/2013.
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Affiliation(s)
- Chao Wu
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Ling Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Shuqing Wang
- Internal Medicine‑Cardiovascular Department, The First Hospital of Qiqihar, Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, Heilongjiang Province, People's Republic of China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan Province, People's Republic of China
| | - Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yanyan Zhao
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Yang Wang
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Wei Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Chen Jin
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Shubin Qiao
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
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15
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Anagaw YK, Yeheyis MM, Ayenew W, Bizuneh GK. Treatment Outcomes of the Acute Coronary Syndrome Among Patients Attending St. Paul Hospital. Ther Clin Risk Manag 2023; 19:105-114. [PMID: 36733976 PMCID: PMC9888011 DOI: 10.2147/tcrm.s382422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Background Acute coronary syndrome (ACS) patients need intense therapy and diagnostic evaluation for improved treatment. In Ethiopia, where patient deaths and hospital stays are rising, the ACS treatment is thought to be not very effective. Methods A retrospective cross-sectional study was conducted at St. Paul Hospital. The data were collected from patients medical records using a structured data abstraction checklist from 2018 to 2020. The data was entered, analyzed, and interpreted using SPSS version 24 software. Results Of 157 ACS patients, 69 (43.9%) had a STEMI diagnosis. Age was 63.69 years on average (SD: 8.23). The typical amount of time between the onsets of ACS symptoms to hospital presentation was 79.3 hours (3.3 days). For 104 (66.2%) patients, hypertension was the main risk factor for the development of ACS. Killip class III and IV patients made up about 3.8% of the ACS patients at St. Paul hospital. An EF of less than 40% was present in 36.3% of patients. Loading doses of aspirin (90.4%), anticoagulants (14%), beta-blockers (82.8%), statins (86%), clopidogrel (7.6%), and nitrates (2.5%) are among the medications taken inside hospitals. Of 157 ACS patients, 6 (3.8%) patients with medical records examined died while receiving treatment in the hospital, while 151 (96.2%) patients were discharged alive. Conclusion STEMI was the most common diagnosis for ACS patients at St. Paul Hospital. The two main hospital events for these patients were CHF and cardiogenic shock.
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Affiliation(s)
- Yeniewa Kerie Anagaw
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Yeniewa Kerie Anagaw, Email
| | - Marshet Mulugeta Yeheyis
- Department of Internal Medicine St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondim Ayenew
- Department of Social & Administrative Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Kassahun Bizuneh
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol 2023; 15:13-22. [PMID: 36714367 PMCID: PMC9850671 DOI: 10.4330/wjc.v15.i1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.
AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
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Affiliation(s)
- Kunaal Makkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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17
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Justin Paul G, Sankaran S, Saminathan K, Iliyas M, Sethupathy S, Saravanan S, Prabhu SS, Kurian S, Srinivas S, Anurag P, Srinivasan K, Manimegalai E, Nagarajan S, Ramesh R, Nageswaran PM, Sangareddi V, Govindarajulu R. Outcomes of ST Segment Elevation Myocardial Infarction without Standard Modifiable Cardiovascular Risk Factors - Newer Insights from a Prospective Registry in India. Glob Heart 2023; 18:13. [PMID: 36936250 PMCID: PMC10022543 DOI: 10.5334/gh.1189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/02/2023] [Indexed: 03/18/2023] Open
Abstract
Objectives Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs. Methods We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5th extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality. Results Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year all-cause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5th eSMuRF yielded similar results. Conclusions 25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.
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Affiliation(s)
- Gnanaraj Justin Paul
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sabarish Sankaran
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Karthikaa Saminathan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Mohamed Iliyas
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Suryakanth Sethupathy
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sivasubramaniam Saravanan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Salai Sudhan Prabhu
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sijoy Kurian
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sandeep Srinivas
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Polavarappu Anurag
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Kumaran Srinivasan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Elavarasi Manimegalai
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Swaminathan Nagarajan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Rajasekar Ramesh
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - P. M. Nageswaran
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Venkatesan Sangareddi
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Ravishankar Govindarajulu
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
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18
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Doddamadaiah C, Nanjappa V, Raveesh H, Javaregowda DC, Sadananda KS, Nanjappa MC. Clinical and Angiographic Profile of Women with Acute Coronary Syndrome from a Large Tertiary Cardiac Care Center in South India – An Observational Study. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives:
Acute coronary syndrome (ACS) is the leading cause of death in women. There are limited studies exclusively in Indian women presenting with ACS. This is the first largest study in south Indian women. To assess Demographic, clinical and angiographic profile of women with ACS.
Materials and Methods:
We collected data regarding baseline clinical, demographics, laboratory investigations, electrocardiogram, echocardiographic assessment, coronary angiogram details, treatment data, and outcomes in women presenting with ACS.
Results:
Majority were in the age group between 55 and 65 year (35.886%). Most common comorbidity seen in our study group is hypertension (59.90%), followed by Diabetes milletus (DM) (54.80%). ACS patients most frequently presented with ST-elevation myocardial infarction (STEMI)-AWMI in postmenopausal group, premenopausal women presented more commonly with non-STEMI. Though SVD is the most common presentation in our study, TVD is most commonly seen in premenopauasal (25.45%) compared to postmenopausal women (11.81%).
Conclusion:
Hypertension is the most common comorbidity seen in our study group, followed by DM. STEMI is the most common presentation. Higher mortality is seen in patients presenting late to the hospital and with higher Killip’s class. More studies are needed in women with ACS.
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Affiliation(s)
- Chaitra Doddamadaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science and Research Centre, Mysuru, Karnataka, India,
| | - Veena Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science and Research Centre, Mysuru, Karnataka, India,
| | - Hema Raveesh
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science and Research Centre, Mysuru, Karnataka, India,
| | - Devaraju Chandagalu Javaregowda
- Department of Clinical Research, Sri Jayadeva Institute of Cardiovascular Science and Research Centre, Mysuru, Karnataka, India,
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Farah Yusuf Mohamud M. Epidemiological Characteristics and Risk Factors Associated with Acute Myocardial Infarction in Somalia: A Single-Center Experience. Int J Gen Med 2022; 15:7605-7617. [PMID: 36213302 PMCID: PMC9532582 DOI: 10.2147/ijgm.s383690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a clinical emergency condition that encompasses STEMI and NSTEMI that leads to significant morbidity and mortality rate. Methods This prospectively cohort study was obtained from adult (≥18 years) patients with definitive diagnosis of AMI based on the International Classification of Diseases (ICD; codes I21, I22) those visiting to our hospital from December 2020 to November 2021. Patients with no definite diagnosis of MI and those having with stable or unstable angina were excluded from the study. Descriptive methods including frequency of tables and bar charts for different categories were used for data analysis. Results Of 23,147 patients, 3526 were presented with chest pain in our emergency unit over the study period. A total of 97 patients met the inclusion criteria of AMI for this analysis. Of them, 73 (75.3%) had STEMI, and 24 (24.7%) had NSTEMI. Those with STEMI, anterior MI was common occlusion site (n=24, 32.9%) followed by inferior MI (n=15, 20.5%). The mean age of patients was 54.2±12.1 years. Of the total study subjects, 67 (69.1%) were males with no significant difference in subgroups. Most of the participants were married (n=41, 42.3%). More than half of the patients were employed (n=51, 52.6%), while most of the participants were no formal education (n-39, 44.2%). Regarding the ASCVD risk factors, history of hypertension, diabetes mellitus, previous history of coronary artery disease (CAD), and dyslipidemia were the most common comorbidities in STEMI and NSTEMI cases, 31 (41.2%), 36 (49.3%), 24 (32.9%) and 15 (20.5%) vs 14 (66.7%), 11 (45.8%), 11 (45.8%), and 6 (25%), respectively. On the initial clinical presentations, typical chest pain and palpitation were the most frequent clinical presenting symptoms in both STEMI and NSTEMI patients of our study (STEMI=80.4% vs NSTEMI=68% in each), followed by dyspnea (STEMI=72.6% vs NSTEMI=41.7%) and epigastric pain (STEMI=32.9% vs NSTEMI=29.2%). The use of aspirin, clopidogrel, and LMWH therapy within the first hours after the emergency were high and comparable in both subgroups (91.8%, vs 89.7% vs 89.7%). The majority of the patients developed heart failure (36.1%), arrhythmia (23.7%), and cardiogenic shock (18%). Conclusion As registered, the present study has a higher proportion of STEMI cases among the AMI participants when compared to the NSTEMI. Hypertension, diabetes, hyperlipidemia, and family history of CAD respectively were the highest prevalence risk factors of AMI.
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Affiliation(s)
- Mohamed Farah Yusuf Mohamud
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Mohamed Farah Yusuf Mohamud, Mogadishu Somali-Turkish Training and Research Hospital, 30 Street, Alikamin, Wartanabada District, Mogadishu, Somalia, Tel +252615591689, Email
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Hendrickson MJ, Arora S, Vaduganathan M, Fonarow GC, MP G, Bansal A, Batra V, Kunal S, Bhatt DL, Gupta M, Qamar A. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail 2022; 9:3836-3845. [PMID: 35950269 PMCID: PMC9773730 DOI: 10.1002/ehf2.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.
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Affiliation(s)
| | - Sameer Arora
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Gregg C. Fonarow
- Division of CardiologyUniversity of California Los AngelesLos AngelesCAUSA
| | - Girish MP
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Ankit Bansal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Vishal Batra
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Shekhar Kunal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Mohit Gupta
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health SystemUniversity of Chicago Pritzker School of MedicineEvanstonILUSA
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Rao BH, N S RR, C S SR, Patel PR, Korabathina R, Raj JP, Azam MS, Rao BA, Yerra SK, Abdullakutty J, Raju PK. Metabolic Risk Factors In First Acute Coronary Syndrome (MERIFACS). Indian Heart J 2022; 74:275-281. [PMID: 35931204 PMCID: PMC9453050 DOI: 10.1016/j.ihj.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. METHODS This is a prospective case-control observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n=2153) were compared with matched controls (n=1210). RESULTS Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (P<0.0001), diabetes - 42.6% vs 12.7% (P<0.0001), smoking - 28.3% vs 9.3% (P<0.0001) and elevated LDL-C - 70.2% vs 57.9% (P<0.0001). MRF: BMI - 54.7% vs55.1% (P=0.84), waist: hip ratio 79.5% vs 63.6% (P<0.0001), high HbA1C - 37.8% vs 14.9% (P<0.0001), low HDL-C - 56.2% vs 42.8% (P<0.0001) and elevated triglycerides - 49.7% vs 44.2%. (P=0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (P<0.001), diabetes - 4.7 (P<0.001), high LDL-C - 3.3 (P<0.001) and smoking- 6.3 (P<0.001). MRF: waist: hip ratio - 2.4 (P<0.001) high HbA1c - 3.2 (P<0.001), low HDL-C 2.2 (P<0.001) and elevated triglycerides - 0.878 P=0.17. CONCLUSION In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF.
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Affiliation(s)
- B Hygriv Rao
- Department of Cardiology, KIMS Hospitals, Hyderabad, India; KIMS Foundation and Research Centre (KFRC), Hyderabad, India; Arrhythmia Research & Training Society, Hyderabad, India.
| | - Rama Raju N S
- Department of Cardiology, KIMS Hospitals, Rajahmundry, India
| | | | | | | | | | - Md Sadiq Azam
- Department of Cardiology, KIMS Hospitals, Hyderabad, India
| | - B Annaji Rao
- Department of Cardiology, KIMS Hospitals, Srikakulam, India
| | - Shiv Kumar Yerra
- Department of Cardiology, KIMS Hospitals, Hyderabad, India; Department of Cardiology, Mahavir Hospital, Hyderabad
| | | | - P Krishnam Raju
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
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22
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Upadhyay AN, Dhasmana M, Kumar B. Impact of Universal Health Insurance on Total Ischemia Time and Door-to-Balloon Time in STEMI: A Single-Center Study from a Geographical Adverse Region. Indian J Community Med 2022; 47:375-378. [PMID: 36438521 PMCID: PMC9693940 DOI: 10.4103/ijcm.ijcm_1118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/22/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION We studied the impact of a Universal Health Insurance (UHI) Scheme introduced in India on total ischemia time (an important determinant of ST-elevation myocardial infarction [STEMI] outcome). MATERIALS AND METHODS This is a retrospective hospital-based comparative study which evaluated the total ischemia time (min) of all the patients presenting with STEMI and undergoing primary angioplasty before (Group A) and after (Group B) implementation of this scheme. RESULTS A total of 221 patients (mean age: 54.18 ± 13.02 years in Group A and 57.59 ± 11.42 years in Group B) were included in the study. Median pain to first medical contact time was 300 and 360 min (P = 0.49), whereas the median first medical contact to percutaneous coronary intervention PCI center time was 330 and 210 min (P = 0.32), for Groups A and B, respectively. A statistically significant difference was noted in the mean door-to-device time between two groups (67.46 ± 33.10 min in Group A vs. 58.48 ± 12.99 min in Group B; P = 0.02). CONCLUSIONS A significant difference in door-to-balloon time was found after implementation of UHI, but total ischemia time was no different. It emphasizes the importance of establishing a system of STEMI care that can decentralize the benefits of early reperfusion like hub-and-spoke model.
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Affiliation(s)
- Amar Nath Upadhyay
- Department of Cardiology, Government Doon Medical College, Dehradun, India
| | | | - Barun Kumar
- Department of Cardiology, AIIMS, Rishikesh, Uttarakhand, India
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23
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Karthikeyan G, Mantoo MR, Bhargava B. Choosing the right model for STEMI care in India - Focus should remain on providing timely fibrinolytic therapy, for now. Indian J Med Res 2022; 156:17-20. [PMID: 36510894 PMCID: PMC9903390 DOI: 10.4103/ijmr.ijmr_600_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India,For correspondence:
| | - Mohsin Raj Mantoo
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India,Secratory, Department of Health Research & Director General, Indian Council of Medical Research, New Delhi 110 029, India
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Takieddin SZ, Alghamdi NM, Mahrous MS, Alamri BM, Bafakeeh QA, Zahrani MA. Demographics and Characteristics of Patients Admitted With Acute Coronary Syndrome to the Coronary Care Unit at King Abdulaziz University. Cureus 2022; 14:e26113. [PMID: 35875268 PMCID: PMC9298687 DOI: 10.7759/cureus.26113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Over the previous decade, the incidence of cardiovascular diseases (CVDs) has risen in the Middle East and will increase mortality to 23 million individuals in Saudi Arabia by 2030, according to the Saudi Ministry of Health. CVDs, including acute coronary syndrome (ACS), are the most common cause of mortality globally. This study aimed to analyze the demographic and clinical characteristics of patients with ACS admitted to the coronary care unit (CCU) in a tertiary hospital in Jeddah, Saudi Arabia. To the best of our knowledge, a lack of research in this region has been undertaken. Methods This retrospective records review study was conducted in a tertiary center in Jeddah, Saudi Arabia. All patients admitted to our CCU in 2017 with a final diagnosis of ACS were retrospectively enrolled. Demographic details, coronary risk factors, investigation and procedures, management, and clinical outcomes are all part of the data. Results Of the 615 patients included in the study, 491 (79.84%) were males, 226 (36.75%) were 55-64 years old, and 161 (26.18%) were 45-54 years old. Males had a higher rate of ST-segment elevation myocardial infarction (STEMI) (214, 43.58%), while females had a higher rate of non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) (45.96% and 37.90%, respectively). Diabetes (62.60%), dyslipidemia (62.44%), and hypertension (61.46%) were the most prevalent risk factors. Angiography and percutaneous coronary intervention (PCI) were performed in 77.72% and 61.95% of patients, respectively. Coronary artery bypass graft was only performed in 4.39% of patients. PCI was performed more frequently in patients with STEMI than in those with NSTEMI/UA (P < 0.001). A large majority of patients (99.5%) recovered and were discharged. Of the 161 (26.18%) patients who attended a follow-up visit, only 45 (33.08%) met the therapeutic objective of 1.8 mmol/L (70 mg/dl) of low-density lipoprotein cholesterol. There were 100 (16.26%) patients readmitted to the CCU, and most of these were readmitted within a year after initial admission. Readmissions were more common in females and patients diagnosed with NSTEMI/UA during initial admission (15.47% and 19.35%, respectively). Conclusion This study revealed that our most common demographics were males between 45 and 64 years, which is a decade younger than the global average. STEMI was the most common presentation. The most common modifiable cardiovascular risk factors were hypertension, diabetes, and dyslipidemia. The most common adverse event was reinfarction, which was closely linked to hypertension and diabetes. In this study, the recovery rate was higher than in studies from other countries; however, the majority of patients did not achieve the goal of cholesterol levels at follow-up. Our population's younger age at presentation necessitates greater attention and more stringent preventive strategies, such as lifestyle changes and evidence-based treatments for CVD risk factors, to reduce the incidence and burden of ACS on CCUs.
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25
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Jayagopal P, Sastry SL, Nanjappa V, Abdullakutty J, Joseph J, Vaidyanathan P, Kabra N, Manokar P, Ghanta SS, Sharma V, Mishra TK, Jathappa N, Singh V, Routray S, Mandal S, Bhalla N, Dorairaj P, Mehta N, Kumbla D, Rane AR, Matia TK, Jain D, Rege G, Modi S, Chopra V, Mohanan P, Geevar Zachariah A, Ravindranath K, Chakraborty R, Srinivas B, Raghu T, Manjunath C. Clinical characteristics and 30-day outcomes in patients with acute decompensated heart failure: Results from Indian College of Cardiology National Heart Failure Registry (ICCNHFR). Int J Cardiol 2022; 356:73-78. [DOI: 10.1016/j.ijcard.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 11/05/2022]
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26
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Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome. Medicina (B Aires) 2022; 58:medicina58020143. [PMID: 35208466 PMCID: PMC8875451 DOI: 10.3390/medicina58020143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives: Excessive coronary thrombus burden is known to cause an increase in mortality and major adverse cardiac events (MACEs) in NSTE-ACS (non-ST acute coronary syndrome) patients. We investigated the association between the systemic immune-inflammation index (SII) and coronary thrombus burden in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography and percutaneous coronary intervention (PCI). Materials and Methods: A total of 389 patients with the diagnosis of NSTEMI participated in our study. Coronary thrombus burden was classified in the TIMI (thrombolysis in myocardial infarction) thrombus grade scale and patients were divided into two groups: a TIMI thrombus grade 0–1 group (n = 209, 157 males) and a TIMI thrombus grade 2–6 group (n = 180, 118 males). Demographics, angiographic lesion images, coronary thrombus burden, clinical risk factors, laboratory parameters, and SII score were compared between the two groups. Results: The high thrombus burden patient group had a higher neutrophil count, WBC count, platelet count, and systemic immune-inflammation index (SII) (p < 0.001). The receiver operating characteristic (ROC) curve analysis showed that at a cutoff of 1103, the value of SII manifested 74.4% sensitivity and 74.6% specificity for detecting a high coronary thrombus burden. Conclusions: Our study showed that the SII levels at hospital admission were independently associated with high coronary thrombus with NSTEMI.
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Ke J, Chen Y, Wang X, Wu Z, Zhang Q, Lian Y, Chen F. Machine learning-based in-hospital mortality prediction models for patients with acute coronary syndrome. Am J Emerg Med 2022; 53:127-134. [PMID: 35033770 DOI: 10.1016/j.ajem.2021.12.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models. METHODS The data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model. RESULTS A total of 6482 ACS patients were included in the study, and the in-hospital mortality rate was 1.88%. Multivariate logistic regression analysis found that age, NSTEMI, Killip III, Killip IV, and levels of D-dimer, cardiac troponin I, CK, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-density lipoprotein (HDL) cholesterol, and Stains were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.884, 0.918, 0.913, and 0.896, respectively. Feature importance evaluation found that NT-proBNP, D-dimer, and Killip were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model. CONCLUSIONS The predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, D-dimer, Killip, cTnI, and LDH as this may improve the clinical outcomes of ACS patients.
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Affiliation(s)
- Jun Ke
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai 201203, China
| | - Xiaoping Wang
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Zhiyong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China
| | - Qiongyao Zhang
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Yangpeng Lian
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Feng Chen
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China.
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The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp190118090k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748?0.761)] were a ge ( ? 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus.
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Singh A, Narain V, Sharma J, Chaudhary G, Vishwakarma P, Yadav S, Dwivedi S. The short outcomes and in-hospital complications in patients with STEMI revascularized with primary PCI: A prospective registry from India. Res Cardiovasc Med 2022. [DOI: 10.4103/rcm.rcm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Kharge J, Parikh CJ, Suranagi MJ, Lakshmanasastry S, Srinivasa KH, Manjunath CN. Indicators and predictors of in-hospital mortality and survival in patients with ventricular septal rupture. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100095. [PMID: 38560076 PMCID: PMC10978188 DOI: 10.1016/j.ahjo.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 04/04/2024]
Abstract
Background Ventricular septal rupture (VSR), a mechanical complication of myocardial infarction (MI), usually presents with rapid clinical deterioration with acute heart failure or cardiogenic shock. VSR may occur within 24 h to several days after MI and can occur in both anterior and inferior wall MI. Although guidelines recommend emergent surgery, this is associated with a high mortality rate of up to 40%. Intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) stabilize patients in preparation for angiography and surgery. Delayed surgery allows better septal repair in scarring tissue but also carries the risk of rupture extension and death while waiting. Percutaneous closure of the defect with appropriately designed devices results in better survival in the subacute phase. Aims To study the indicators and predictors of VSR in the current era of primary percutaneous coronary interventions and mechanical circulatory support. Methods Of total of 34,681 patients presenting with MI, the incidence of VSR was 0.45%. We sought to evaluate the predictors of survival and death in VSR. Coronary angiography (CAG) was performed, hemodynamic support provided to unstable patients, and consenting patients were referred to definitive therapy, either surgery or percutaneous device closure. The previously postulated hypotheses of triple vessel disease (TVD), diabetes mellitus (DM), and concentric left ventricular hypertrophy (LVH) due to Hypertension (HTN) being protective against VSR were explored. Results Of the 169 patients with VSR, we found that the group that survived was mostly men and the mean age was 61.5 years; this was in contrast to the non-survivors, who were mainly women, and the mean age was 65.2 years (p = 0.025); higher Killip Class was 111-1V (p = 0.001), lower LVEF (p = 0.010), apical VSR and LV aneurysm (p = 0.015 and p = 0.002, respectively) were predictors of death. 48 patients underwent CAG, with single vessel disease (SVD) with lower-grade Rentrop collateral flow being most common in the death group. 25 patients were subjected to definitive therapy with surgical patch closure or percutaneous device closure. The patients who died were older by approximately 7 years. The risk factors for coronary artery disease, such as HTN, diabetes, and smoking, were not statistically different between the two groups. Conclusion Prevention of myocardial infarction is more important than managing a VSR, which carries a high mortality despite advanced mechanical support and definitive interventional therapy such as emergent surgery and percutaneous device closure.
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Affiliation(s)
- Jayashree Kharge
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Joseph S, Panniyammakal J, Abdullakutty J, S S, Vaikathuseril L J, Joseph J, Mattummal S, Punnose E, Unni G, Natesan S, Sivadasanpillai H. The Cardiology Society of India-Kerala Acute Heart Failure Registry: poor adherence to guideline-directed medical therapy. Eur Heart J 2021:ehab793. [PMID: 34931232 DOI: 10.1093/eurheartj/ehab793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 11/03/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS Data on the burden of acute heart failure (AHF) admissions, practice patterns, and outcomes are rare from India and other low- and middle-income countries. We aimed to describe the baseline characteristics, guideline-directed medical therapy (GDMT) prescribing patterns and 90-day mortality rates in patients admitted with AHF in Kerala, India. METHODS AND RESULTS The Cardiology Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR) is an observational registry from 50 hospitals in Kerala, India, with prospective follow-up. Consecutive patients with AHF, who consented to participate, were enrolled. The 2016 European Society of Cardiology criteria were used for the diagnosis of AHF. Kaplan-Meier survival analysis and Cox-proportional hazard models were used for data analysis. The variables in the MAGGIC risk score were used in the multivariable model. A total of 7507 patients with AHF (37% female) participated in the CSI-KHFR. The mean age was 64.3 (12.9) years. More than two-third had reduced ejection fraction (EF) (67.5%). Nearly one-fourth (28%) of patients with heart failure (HF) with reduced EF received GDMT. Overall, in-hospital and 90-day mortality rates were 7% and 11.6%, respectively. Prescriptions of different components of GDMT were independently associated with 90-day mortality. CONCLUSION The CSI-KHFR recorded an in-hospital and 90-day mortality of 7% and 11.6%, respectively. Only one of four patients received GDMT. AHF mortality was independently associated with GDMT initiation. Quality improvement initiatives that focus on increasing GDMT prescription may improve the survival of HF patients in India.
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Affiliation(s)
- Stigi Joseph
- Department of Cardiology, Little Flower Hospital and Research Centre, Angamaly, Ernakulam, Kerala 683572, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Cardiogenic Shock Among Patients with and without Acute Myocardial Infarction in a Latin American Country: A Single-Institution Study. Glob Heart 2021; 16:78. [PMID: 34900569 PMCID: PMC8641529 DOI: 10.5334/gh.988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Latin America has limited information about the full spectrum cardiogenic shock (CS) and its hospital outcome. This study sought to examine the temporal trends, clinical features and outcomes of patients with CS in a coronary care unit of single Mexican institution. Methods: This was a retrospective study of consecutive patients hospitalized with CS in a Mexican teaching hospital between 2006–2019. Patients were classified according to the presence or absence of acute myocardial infarction (AMI). Results: Of 22,747 admissions, 833 (3.7%) exhibited CS. Among patients with AMI (n = 12,438), 5% had AMI–CS, and in patients without AMI (n = 10,309), 2.3% developed CS (non-AMI–CS). Their median age was 63 years and 70.5% were men. Cardiovascular risk factors were more frequent among the AMI–CS group, whereas a history of heart failure was greater in non-AMI–CS patients (70.1%). In AMI-CS patients, the median delay time was 17.2 hours from the onset of AMI symptoms to hospital admission. Overall, the median left ventricular ejection fraction (LVEF) was 30%. Patients with CS at admission showed end-organ dysfunction, evidenced by lactic acidosis, renal impairment, and elevated liver transaminases. Of the 620 AMI–CS patients, the main cause was left ventricular dysfunction in 71.3%, mechanical complications in 15.2% and right ventricular infarction in 13.5%. Among the 213 non-AMI–CS patients, valvular heart disease (49.3%) and cardiomyopathies (42.3%) were the most frequent etiologies. In-hospital all-cause mortality rates were 69.7% and 72.3% in the AMI–CS and non-AMI–CS groups, respectively. Among AMI–CS patients, renal dysfunction, diabetes, older age, depressed LVEF, absence of revascularization and the use of mechanical ventilation were independent predictors of in-hospital mortality. However, in the non-AMI–CS group, only low LVEF and high lactate levels proved significant. Conclusions: This study demonstrates differences in the epidemiology of CS compared to high-income countries; the high mortality reflects critically ill patients and the lack of contemporary effective therapies in the population studied.
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Mathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf S, Fischer L, Abdullakutty J, Pisharody S, Bainey K, Graham M. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score–Matched Analysis. CJC Open 2021; 3:S71-S80. [PMID: 34993436 PMCID: PMC8712709 DOI: 10.1016/j.cjco.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results. Methods A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)–capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score–matched groups were compared. Results We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups. Conclusions Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
- Corresponding author: Dr Anoop Mathew, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, 2C2 WMC, 8440 – 112 St, NW, Edmonton, Alberta T6G 2B7, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | - S.M. Ashraf
- Division of Cardiology, Government Medical College Hospital, Pariyaram, Kerala, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | | | - Sunil Pisharody
- Division of Cardiology, Elamkulam Manakkal Sankaran Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Kerala, India
| | - Kevin Bainey
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
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Panda P, Singh NV, Kaur N, Kaur P, Kaur A, Aujla HK, Kaur K, Saini N, Kapoor S, Paul Sharma Y. Delay in Seeking Medical Treatment Among Patients With Acute Coronary Syndrome. Cureus 2021; 13:e17369. [PMID: 34567908 PMCID: PMC8455286 DOI: 10.7759/cureus.17369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Background Various Indian registries have documented a delay of more than five hours for acute coronary syndrome patients from onset of symptoms to reaching thrombolysis-enabled centres. We conducted this study to evaluate the factors responsible for pre-hospital delay in acute coronary syndrome patients. Methods This was a descriptive cross-sectional study conducted in consecutive acute coronary syndrome patients who reported to the tertiary care medical centre in North India. A standardized tool was used to record the demographic data, socioeconomic status and clinical presentation of patients. All factors which led to pre-hospital delay were noted and the appropriate statistical tests were used for analysis. Results A total of 130 patients (males=93, females=37) were included in the study. The median time at which the acute coronary syndrome patients presented to the thrombolysis and percutaneous coronary intervention enabled centre was 490 minutes (range: 20 - 810 minutes) and 710 minutes (range: 45 - 940 minutes) respectively. The various factors responsible for prehospital delay were rural residence (p-value <0.0001), visit to local dispensary (p-value=0.0023), delay in getting transport (p-value=0.03) and misinterpretation of cardiac symptoms (p-value=0.0004). A significant but weak negative correlation was found between per capita income, decision making time and time taken to receive thrombolytic therapy. Out of a total of 83 ST-elevation myocardial infarction patients, only 46 (51.80%) were thrombolysed. Though 69/83 (83.13%) ST-elevation myocardial infarction patients reached thrombolysis enabled centre directly, only nine (10.84%) were thrombolysed at first medical contact; the rest were transferred to the percutaneous coronary intervention-enabled centre without any prior information. Conclusion Our study concludes that besides socioeconomic and demographic variables, lack of public awareness, well established public transport & health insurance system lead to significant pre-hospital delays and increase the time to revascularization. Besides, judgemental error on the part of medical practitioners in the peripheries also significantly delays thrombolysis in ST-elevation myocardial infarction patients.
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Affiliation(s)
- Prashant Panda
- Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Neena Vir Singh
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Navjyot Kaur
- Cardiology, Command Hospital Air Force, Bangalore, IND
| | - Prabhjot Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Avneet Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Harleen Kaur Aujla
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Khushpreet Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Nishtha Saini
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Shakshi Kapoor
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Yash Paul Sharma
- Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
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Fanta K, Daba FB, Asefa ET, Melaku T, Chelkeba L, Fekadu G, Gudina EK. Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Front Cardiovasc Med 2021; 8:707700. [PMID: 34604351 PMCID: PMC8484752 DOI: 10.3389/fcvm.2021.707700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.
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Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene Asefa
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
- Department of Clinical Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
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Khan MY, Pandit S, Guha S, Jadhav U, Rao MS, Gaurav K, Mane A, Dubey A, Bhagwatkar H, Venkataswamy K, Shah S. Demographic profile, clinical characteristics and medical management patterns of Indian coronary artery disease patients: a nationwide urban-based, real-world, retrospective, observational electronic medical record study- report of baseline data. Expert Rev Cardiovasc Ther 2021; 19:769-775. [PMID: 34126829 DOI: 10.1080/14779072.2021.1941872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.
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Affiliation(s)
- Mohammed Yunus Khan
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Sucheta Pandit
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Santanu Guha
- Medical College and Hospital, Kolkata, West Bengal, India
| | | | | | - Kumar Gaurav
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Amey Mane
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Akhilesh Dubey
- Prime Health Clinic and Galaxy Hospital, Jabalpur, India
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Alexander T, Mullasari A, Nallamothu B. Management strategies for acute STEMI in low- and middle-income countries: experience of the Tamil Nadu ST-segment elevation myocardial infarction programme: Management strategies for STEMI in LMIC. ASIAINTERVENTION 2021; 7:27-34. [PMID: 34912999 PMCID: PMC8670567 DOI: 10.4244/aij-d-21-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 06/14/2023]
Abstract
Appropriate and timely management of ST-elevation myocardial infarction is a major challenge in developing countries due to inadequate infrastructure and trained manpower. The TN-STEMI Program was a successful STEMI system of care that was run in the South Indian state of Tamil Nadu. Lessons learnt from this programme could help to understand the challenges and provide solutions to running similar programmes in low- and middle-income countries.
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Affiliation(s)
- Thomas Alexander
- Kovai Medical Centre and Hospital, 99 Avanashi Rd, Coimbatore, Tamil Nadu, 641014, India. E-mail:
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
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Zachariah G, Ramakrishnan S, Das MK, Jabir A, Jayagopal PB, Venugopal K, Mani K, Khan AK, Malviya A, Gupta A, Goyal A, Singh BP, Mohan B, Bharti BB, Majumder B, Wilson B, Karunadas CP, Meena CB, Manjunath CN, Cibu M, Roy D, Choudhary D, Das DR, Sarma D, Girish MP, Wander GS, Wardhan H, Ezhilan J, Tummala K, Katyal VK, Goswami K, Subramanyam K, Goyal KK, Kumar K, Pathak LA, Bansal M, Mandal M, Gupta MD, Khanna NN, Hanumanthappa NB, Bardoloi N, Modi N, Naik N, Hasija PK, Kerkar P, Bhattacharyya PJ, Gadkari P, Chakraborthy RN, Patil RR, Gupta R, Yadav R, Murty RS, Nath RK, Sivakumar R, Sethi R, Baruah R, Tyagi S, Guha S, Krishnappa S, Kumar S, Routray SN, Tewari S, Ray S, Reddy SS, Chandra S, Gupta SB, Chatterjee SS, Siddiqui KKH, Sivabalan M, Yerram S, Kumar S, Nagarajan S, Devasia T, Jadhav U, Narain VS, Garg VK, Gupta VK, Prabhakaran D, Deb PK, Mohanan PP. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic. Indian Heart J 2021; 73:413-423. [PMID: 34474751 PMCID: PMC8424286 DOI: 10.1016/j.ihj.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
AIM Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | - Kalaivani Mani
- Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | | | | | - B P Singh
- Department of Cardiology, Indra Gandhi Institute of Medical Sciences, Patna, India
| | | | | | | | | | | | | | | | | | - Debabrata Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - Dipak Sarma
- Christian Medical Centre Hospital, Jorhat, India
| | | | | | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Virender Kumar Katyal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kewal Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Manoranjan Mandal
- Department of Cardiology, Nil Ratan Sircar Medical College, Kolkata, India
| | | | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Rishi Sethi
- King George Medical University, Lucknow, India
| | | | - Sanjay Tyagi
- Department of Cardiology, GB Pant Hospital, New Delhi, India
| | | | - Santhosh Krishnappa
- Cardiology Department, Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, India
| | | | - Satya Narayan Routray
- Department of Cardiology, Srirama Chandra Bhanja Medical College and Hospital, Odissa, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | | | | | | | | | | | - Sreekanth Yerram
- Department of Cardiology, Nizam's Institute of Medical Science, Hyderabad, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Uday Jadhav
- Consultant in Cardiology Department, MGM New Bombay Hospital, Mumbai, India
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Salwan R, Seth A. Development of ST-elevation Myocardial Infarction Programs in Developing Countries: Global Challenges and Solutions. Interv Cardiol Clin 2021; 10:401-411. [PMID: 34053626 DOI: 10.1016/j.iccl.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide; approximately 80% of CVD deaths occur in low-income and middle-income countries (LMICs). The epidemiologic transition to a high burden of ischemic heart disease (IHD) has happened with greater rapidity in LMICs than in high-income countries. The absolute number of individuals with premature IHD has increased substantially. Higher event rates are observed compared with high-income countries. The technological capability to do extraordinary things for patients has increased, as has patient demand, in a setting of constrained resources and expensive health care of variable quality.
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Affiliation(s)
- Roopa Salwan
- Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Ashok Seth
- Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
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Otaal PS, Shah A, Batta A, Sood A, Pal A. Clinical and Angiographic Prophesy of Hemodynamic Status in Patients with Acute Anterior Wall ST-Segment-Elevation Myocardial Infarction and Totally Occluded Left Anterior Descending Artery. Integr Blood Press Control 2021; 14:89-97. [PMID: 34168494 PMCID: PMC8219224 DOI: 10.2147/ibpc.s315050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients. Methods In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated. Results Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037). Conclusion The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.
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Affiliation(s)
- Parminder Singh Otaal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Shah
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Alexander T, Victor SM, Jayakumaran B, Rajan S, Mullasari S A. Sex-related Differences in Outcomes for Patients With ST Elevation Myocardial Infarction (STEMI): A TN-STEMI Program Subgroup Analysis. Heart Lung Circ 2021; 30:1870-1875. [PMID: 34088626 DOI: 10.1016/j.hlc.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND ST elevation myocardial infarction (STEMI) represents a large proportion of the clinical presentation of coronary artery disease in Indian people. Owing to multiple factors contributing to the sex difference, women with STEMI are thought to have a higher risk of adverse outcomes than men. The aim of this study was to evaluate sex-related differences in the clinical characteristics and prognosis of patients with STEMI within a system of care. METHOD This study was a subgroup analysis of the Tamil Nadu-STEMI (TN-STEMI) program, a multicentre, prospective, observational study of a quality-improvement program studying patients with STEMI at four hub-and-spoke clusters in the southern state of Tamil Nadu, India. In total, 2,420 patients were enrolled between 2012 and 2014, and the data from all four clusters, pre- and postimplementation of integrated STEMI systems, were combined for this analysis, with a 1-year follow-up. RESULTS The mean ± SD age of presentation of female patients (16%) was significantly later (60.1±10.9 years) compared with males (84%; 53.7±12 years). Diabetes was more prevalent in women (35.2% vs 23.8%; p<0.001), as was hypertension (35.2% vs 22.9%; p<0.001). Symptom to first medical contact in female patients was significantly delayed compared with males (193 mins vs 170 mins; p≤0.009). Women had higher mortality, both in hospital (10.4% vs 4.8%; p≤0.001) and at 1 year (26.7% vs 13%; p≤0.001). This pattern was persistent, even in the younger STEMI (<45 years) population (in-hospital: 9.1% vs 3% [p≤0.05]; at 1 year: 18.2% vs 3% [p≤ 0.05]). In the regression model, females had a 1.8 times increased likelihood (p<0.04) of mortality after adjusting for confounders. CONCLUSIONS Among patients with STEMI, women have an unfavourable risk profile and adverse short- and long-term prognoses when compared to men.
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Affiliation(s)
| | | | | | - Sabari Rajan
- Kovai Medical Centre Hospital, Coimbatore, Tamil Nadu, India
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Acute ST-Elevation Myocardial Infarction in the Young Compared With Older Patients in the Tamil Nadu STEMI Program. Heart Lung Circ 2021; 30:1876-1882. [PMID: 34088627 DOI: 10.1016/j.hlc.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/25/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the clinical presentation, risk factors and outcomes of young patients (≤45 years) presenting with ST segment-elevation myocardial infarction (STEMI) with older STEMI patients in the Tamil Nadu STEMI program (TN-STEMI). METHODS A total of 2,420 patients were enrolled in the TN-STEMI program, which is a pre-implementation and post-implementation quality of care study. The cohort of patients was divided into young STEMI patients (≤45 years) and compared with those aged >45 years. RESULTS A total of 591(24.4%) patients in this cohort were aged ≤45 years; 92.5% of the young STEMI were males. Smoking was the most common risk factor and its use was significantly more in younger myocardial infarction (MI) patients than in older patients (57% vs 31%; p<0.001). Compared with their older counterparts, younger patients had a lower prevalence of hypertension (14.2% vs 28.3%; p<0.001) and diabetes mellitus (13.2% vs 29.7%; p<0.001). Total ischaemic time was shorter for younger patients (235 vs 255 mins; p=0.03). Young STEMI patients more frequently presented with single vessel disease and the left anterior descending coronary artery was the most common infarct-related artery; they also had a higher thrombus load. Young MI patients had reduced mortality, both in-hospital (3.4% vs 6.4%; p=0.005) and at one year (7.6% vs 17.6%; p<0.001). Younger male STEMI patients also showed lower mortality than younger female patients. CONCLUSIONS Young STEMI patients compared with older STEMI patients had lower prevalence of traditional risk factors, shorter ischaemic time and reduced mortality. Young female STEMI patients had higher mortality than young male STEMI patients.
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Scholz KH, Meyer T, Lengenfelder B, Vahlhaus C, Tongers J, Schnupp S, Burckhard R, von Beckerath N, Grusnick HM, Jeron A, Winter KD, Maier SKG, Danner M, Vom Dahl J, Neef S, Stefanow S, Friede T. Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction. Open Heart 2021; 8:openhrt-2021-001650. [PMID: 33958491 PMCID: PMC8103948 DOI: 10.1136/openhrt-2021-001650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/26/2022] Open
Abstract
Background In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion. Aims To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times. Methods A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included. Results There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001). Conclusions Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours. Trial registration number NCT00794001.
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Affiliation(s)
- Karl Heinrich Scholz
- Department of Cardiology and Intensive Care, St Bernward Hospital, Hildesheim, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Christian Vahlhaus
- Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - Jörn Tongers
- Department of Cardiology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Rainer Burckhard
- Department of Cardiology, Donauisar Klinikum Deggendorf, Deggendorf, Germany
| | | | | | - Andreas Jeron
- Department of Cardiology, Rems-Murr-Kliniken, Winnenden, Germany
| | | | - Sebastian K G Maier
- Department of Cardiology, Klinikum Sankt Elisabeth Straubing, Straubing, Germany
| | - Michael Danner
- Department of Cardiology, Städtisches Klinikum, München Neuperlach, Munich, Germany
| | - Jürgen Vom Dahl
- Department of Cardiology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Stefan Neef
- Department of Cardiology, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Stefanow
- Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Ludwigsburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
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Stevenson A, Kirresh A, Ahmad M, Candilio L. Robotic-assisted PCI: The future of coronary intervention? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:161-168. [PMID: 33867293 DOI: 10.1016/j.carrev.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Abstract
Robotic percutaneous coronary intervention (R-PCI) is a novel approach to performing percutaneous coronary intervention (PCI) whereby the operator can utilise remotely controlled technology to manipulate guidewires and catheter devices. This enables the procedure to be undertaken from within a radiation-shielded cockpit. Success in early trials has led to the release of commercially available robotic platforms which have now received regulatory approval and are available for use in clinical practice. Recent trials evaluating R-PCI have demonstrated high technical success rates with low complication rates. Despite this, a significant number of cases, particularly those with complex anatomy, still require at least partial conversion to a manual procedure. Advantages of R-PCI include accurate stent placement, reduced operator radiation exposure and a presumed reduction in orthopedic injuries. Limitations include current incompatibility with certain intravascular imaging catheters and the inability to manipulate multiple guidewires and stents simultaneously. Patients presenting with ST-elevation myocardial infarction requiring primary-PCI have also largely been excluded from existing R-PCI studies. Given these caveats, R-PCI remains a novel technology and has yet to become commonplace in cardiac catheterisation laboratories, however with increasing safety and feasibility data emerging, it is possible that R-PCI may form part of standard practice in the future.
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Affiliation(s)
- Alexander Stevenson
- Department of Intensive Care, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland.
| | - Ali Kirresh
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Luciano Candilio
- Department of Cardiology, Royal Free Hospital, London, United Kingdom of Great Britain and Northern Ireland
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Fanta K, Daba FB, Tegene E, Melaku T, Fekadu G, Chelkeba L. Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study. BMC Emerg Med 2021; 21:41. [PMID: 33789565 PMCID: PMC8010978 DOI: 10.1186/s12873-021-00433-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. Methods A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. Results Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients. Conclusion In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00433-3.
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Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia.
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia
| | - Ginenus Fekadu
- Department of clinical pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New territory, Hong Kong
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, Collage of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Rangashamaiah S, Hayagreev V, Krishnan S, Prabhavathi B, Manjunath CN. The impact of COVID19 nationwide lock-down on STEMI hospitalization and outcomes in South India. Indian Heart J 2021; 73:379-381. [PMID: 34154762 PMCID: PMC7989664 DOI: 10.1016/j.ihj.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Covid-19 Nationwide lockdown for social containment was implemented on the 23rd of March 2020. The objective of this study was to look at the impact of lockdown on STEMI (<24hrs window period). This study was done in 2 phases, 43 days before (phase1) and 43 days during lockdown (phase 2). During the lockdown, there was a 31% decrease in hospital admission rates, 11.5% and 9.38% proportional increase in diabetics and hypertensive patients presenting with STEMI. The public must be educated about the existing important health problems in the community along with the pandemic warnings.
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Affiliation(s)
- Sriranga Rangashamaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560069, Karnataka, India.
| | - Vibha Hayagreev
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560069, Karnataka, India
| | - Shanmugam Krishnan
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560069, Karnataka, India
| | - Bhat Prabhavathi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560069, Karnataka, India
| | - Cholenahalli Nanjappa Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, 560069, Karnataka, India
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Bush N, Sharma YP, Prasad K, Kumar P, Mehrotra S. Comparison of demographic profile, risk factors, and in-hospital outcome in young and old patients with acute coronary syndrome: A single-center experience. J Family Med Prim Care 2021; 10:871-876. [PMID: 34041091 PMCID: PMC8138388 DOI: 10.4103/jfmpc.jfmpc_1975_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/16/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Coronary artery disease (CAD) is witnessing a demographic transition with increasing prevalence in younger individuals. Data is scarce comparing various characteristics of acute coronary syndrome (ACS) between young and old patients in an Indian setting. Hence, we evaluated the epidemiological, demographic, risk factor, and outcome profile of young and old ACS patients in Indian setting. Methods: This was a prospective observational study, which enrolled 50 consecutive ACS patients each into two groups: younger (≤45 years) and elderly (>45 years), respectively. Comparison of clinical presentation, electrocardiography, echocardiographic findings, conventional, nonconventional risk factors, and in-hospital outcomes including duration of hospital stay and major adverse cardiac events (MACE) were made between the two groups. Multivariate regression analysis of risk factors as determinants of MACE adjusting for other confounding factors was also performed. Results: Fifty patients in each group were compared. Mean age in the younger and elderly group was 36 ± 4.69 and 61.58 ± 10.69 years, respectively. Male sex, smoking, family history of CAD, hyperhomocysteinemia, and obesity were observed more in the younger population. While dyslipidemia, low physical activity, diabetes mellitus, and history of previous ACS was more in the older population. Single-vessel disease was more common in younger patients while multivessel involvement was more common in elderly patients. Older patients had longer hospital stays and more in-hospital MACE including deaths. By multivariate analysis, shock was found to be an independent predictor of MACE in both groups. Conclusion: Younger ACS patients have a different risk profile and better in-hospital outcomes compared to older patients.
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Affiliation(s)
- Nikhil Bush
- Department of Internal Medicine, Post Graduate institute of Medical Education and Research, Chandigarh, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate institute of Medical Education and Research, Chandigarh, India
| | - Krishna Prasad
- Department of Cardiology, Post Graduate institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Kumar
- Department of Internal Medicine, Post Graduate institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Mehrotra
- Department of Cardiology, Post Graduate institute of Medical Education and Research, Chandigarh, India
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Muraleedharan M, Chandak AO. Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-04-2020-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.
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Akhtar Z, Aleem MA, Ghosh PK, Islam AKMM, Chowdhury F, MacIntyre CR, Fröbert O. In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh. BMC Cardiovasc Disord 2021; 21:85. [PMID: 33568047 PMCID: PMC7877023 DOI: 10.1186/s12872-021-01896-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/31/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. METHODS We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of all-cause death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE. RESULTS A total of 601 patients, mean age 51.6 ± 10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8 ± 2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI 1.64-13.23). CONCLUSIONS A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.
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Affiliation(s)
- Zubair Akhtar
- Programme for Emerging Infections, International Center for Diarrhoeal Diseases, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Mohammad Abdul Aleem
- Programme for Emerging Infections, International Center for Diarrhoeal Diseases, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Probir Kumar Ghosh
- Programme for Emerging Infections, International Center for Diarrhoeal Diseases, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases Dhaka (NICVD), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Programme for Emerging Infections, International Center for Diarrhoeal Diseases, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - C Raina MacIntyre
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
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50
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Mujtaba SF, Sohail H, Ram J, Waqas M, Hassan M, Sial JA, Naseeb K, Saghir T, Karim M. Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center. Cureus 2021; 13:e12964. [PMID: 33654629 PMCID: PMC7912978 DOI: 10.7759/cureus.12964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.
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Affiliation(s)
- Syed F Mujtaba
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Hina Sohail
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jaghat Ram
- Cardiology, National Institute of Cardiovascular Diseases, Larkana, PAK
| | - Muhammad Waqas
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Hassan
- Cardiology, National Institute of Cardiovascular Diseases, Larkana, PAK
| | - Jawaid A Sial
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Khalid Naseeb
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tahir Saghir
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Musa Karim
- Statistics, National Institute of Cardiovascular Diseases, Karachi, PAK
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