Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Abstract

Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.

Always Clinical Comes Before Angiography

“…7 A Karnataka study, wherein out of 651 patients with ACS, majority of whom who belonged to the lower income group by the Kuppuswamy classification, dyslipidemia was seen in 34.6% of the patients without any significant difference between STEMI and NSTE-ACS groups. 8 Of course, this is consistent with the fact that all patients with dyslipidemia need not develop ACS and reemphasizes the importance of obtaining angiographic profile of those presenting with ACS.…”

Triglyceride to High Density Lipoprotein Cholesterol Ratio in Acute Myocardial Infarction And Its Relationship with Angiographic Severity

“…Almost similar result has been observed by other study. 14,16 This study showed that patients with TG/HDL-C ≥4 have severe CAG findings in terms of all the three parameters like, significant stenosis, vessel number and Gensini tertile compared to the patients with TG/HDL-C <4. About 38.3% patients without significant obstruction had high TG/HDL-C ratio (≥4) whereas 61.7% patients with significant obstruction had high TG/HDL-C ratio (≥4).…”

An observational study on clinical profile of acute coronary syndrome among young adults attending a tertiary care institute in Maharashtra

“…1,2 ACS is most common cause of hospital admissions even in middle income countries like India. 3,4 ACS in an early age is one of the important causes of sudden death. 3,4 It has catastrophic affects on the quality of life of the patients and their family members.…”

“…3,4 ACS in an early age is one of the important causes of sudden death. 3,4 It has catastrophic affects on the quality of life of the patients and their family members. Incidence of ACS is positively correlated with age.…”

“…Also, the clinical practice guidelines for diagnosis and management are clearly documented for older adults. 1,[4][5][6] The profile among this subset appears to be different from the older adults in terms of clinical presentation, risk factors, clinical outcome and pattern of coronary artery involvement.…”