Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India

Abstract

Background Cardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome. Methods We did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018–June 2019). Results The mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p < 0.001). Female gender (OR−3.306 C.I. 1.87–5.845), severe MR (OR−4.65, C.I.−1.187–18.18), acute kidney injury (AKI) at admission (OR-5.15, C.I.−2.5–10.63), higher Killip class (class III/IV) (OR−3.378,C.I.−1.292–8.849), AF (OR−3.25, C.I.−1,18–8.92), complete heart block (CHB) (OR−4.44,C.I.−2.09–9.43) and right bundle branch block (RBBB) (OR−2.86, C.I.−1.2–6.8) were significant predictors of in hospital mortality. Conclusions Our study represents the predominance of STEMI as the initial ACS presentation with a considerable delay in first medical contact and higher prevalence of cardiogenic shock (CS). STEMI patients had higher mortality. Female sex, severe MR, AKI, higher Killips class, AF, CHB, RBBB being predictors of high in-hospital mortality in ACS patients.

Delay in Seeking Medical Treatment Among Patients With Acute Coronary Syndrome

“…STEMI was the most common presentation, similar to some other Indian studies [12,14]. The median time of presentation after the onset of symptoms to this hospital was 710 minutes; while the median time to reach an appropriate medical centre was 490 minutes which is also similar to as reported by other Indian studies [12,14]. Only around 50% of the STEMI patients could be thrombolysed, as documented earlier [11][12][13][14].…”

“…The mean age (61.3 ± 13.4 years) and male preponderance (71.54%) in the index study were similar to the previous study done in the same centre [14]. STEMI was the most common presentation, similar to some other Indian studies [12,14]. The median time of presentation after the onset of symptoms to this hospital was 710 minutes; while the median time to reach an appropriate medical centre was 490 minutes which is also similar to as reported by other Indian studies [12,14].…”

“…The mean age (61.3 ± 13.4 years) and male preponderance (71.54%) in the index study were similar to the previous study done in the same centre [14]. STEMI was the most common presentation, similar to some other Indian studies [12,14].…”

“…Various Indian registries have documented a delay of 300-780 minutes after the onset of ACS symptoms [6,[11][12][13][14]. Delay in GDMT in ACS patients leads to increased mortality and morbidity.…”

“…The initial delay in presentation, lack of an adequate number of PCI-enabled centres, insufficient round the clock functional catheterization laboratories and financial constraints make primary PCI a distant dream in this part of the world. For these reasons, pharmaco-invasive therapy has been accepted as a close, though inferior alternative [6,[11][12][13][14]. Even for pharmaco-invasive therapy, patients should present within 12 hours of symptom onset [8][9][10].…”