Management of acute coronary syndromes in a developing country; time for a paradigm shift? an observational study

Abstract

BackgroundThere are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. We aimed to identify the critical issues that limit optimal management of ACS in Sri Lanka.MethodsWe performed a prospectively observational study of 256 consecutive patients who presented with ACS between November 2011 and May 2012 at a tertiary care general medical unit in Sri Lanka.ResultsWe evaluated data on presentation, management, in-hospital mortality, and major adverse cardiovascular events (MACE) of participants. Smoking, alcohol abuse, and obesity were more common in patients with ST elevation myocardial infarction (STEMI) (P < 0.05). Discharge diagnoses were STEMI in 32.8 % (84/256) and unstable angina (UA)/non-ST elevation myocardial infarction [NSTEMI] in 67.1 % (172/256) of participants. The median time (IQR) from onset of pain to presentation was 60 (319) minutes for STEMI and 120 (420) for UA/NSTEMI (P = 0.058). A median delay of 240 min was noted in patients who had presented initially to smaller hospitals. Cardiac markers were assessed in only 35 % of participants. In-hospital anti-platelet use was high (>92 %). Only 70.2 % of STEMI patients received fibrinolytic therapy. Fewer than 20 % of patients were received fibrinolytic therapy within 30 min of arrival. Major adverse cardiac events (MACE) were recorded in 11.9 % of subjects with STEMI and 11.6 % of those with UA/NSTEMI (P = 0.5). According to logistic regression analysis, body mass index (P = 0.045) and duration of diabetes (P = 0.03) were significant predictors of in-hospital MACE. On discharge, aspirin, thienopyridine, and statins were prescribed to more than 90 % of patients. Only one patient underwent coronary angiography during the index admission.ConclusionsDelays in presentation and in initiation of thrombolytic therapy and coronary interventions are key hurdles that need attention to optimize ACS care in Sri Lanka.

Medical care of acute myocardial infarction patients in a resource limiting country, Trinidad: a cross-sectional retrospective study

“…The proportion of patients thrombolysed ( n = 356/505, 70.5%) compares well or is even better than in other developing countries. In Sri Lanka, 70.2% of STEMI patients receive thrombolysis [23], 41% of STEMI patients in India [24], 44.7% in Cape Town [18], 59% in Iran [25], 62% in Kenya [26] and 27% at a tertiary-care hospital in Sri Lanka [27]. Our study also compares well with studies from first world countries such as Scotland [28].…”

Pre-event quality of life and its influence on the post-event quality of life among patients with ST elevation and non-ST elevation myocardial infarctions of a premier province of Sri Lanka

“…It was observed that the STEMI: NSTEMI ratio was approximately 1: 5. This is an exaggeration of the documented local prevalence mentioned by Medagama and others in 2015 [ 8 ]. It is, however, on par with the current trend of European countries and in contrast to the prevalence recorded in some African countries [ 10 , 11 ].…”

“…Coronary heart disease has been a burden for developed countries as well as for developing countries [ 3 – 7 ]. Sri Lanka, being a LMI country, suffers from the consequences of these cardiovascular diseases [ 8 ]. Myocardial Infarction (MI) is one of the main acute critical effects which reflect the tip of the iceberg of chronic NCDs.…”

“…In contrast, a rising trend of NSTEMI is currently observed among the European countries [ 10 ]. In an observational study, the STEMI:NSTEMI ratio for a tertiary care medical unit in Sri Lanka was found to be 1:2 [ 8 ].…”

Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

“…Data from the United States alone suggest that approximately 0.55 million first episodes and 0.2 million repeated episodes of acute MI occur annually [8], while 15 million people suffer from stroke worldwide with five million deaths and leaving another five million permanently disabled annually [9]. Together, MI and stroke have affected large numbers of people around the world [10][11][12] including Korea [13].…”