In hospital Mortality and correlates among patients admitted for Acute Coronary Syndrome in South India

 

Vinoth Khanna¹, Priya Anbarasan^2*, Abhinaya Shanmugasundaram³

 

 

Abstract              Context: Acute Coronary Syndromes (ACS) is one of the most common causes of a visit to the emergency department among adults. Majority of the Acute Coronary Syndromes are managed in Govt facilities. However, studies on the outcome of ACS among patients treated in these settings are rare. Hence, this study was planned to estimate in-hospital mortality and to identify the factors associated with death among patients admitted in a tertiary teaching institute in South India. Methods: This study was conducted among consecutive patients admitted in the emergency dept with acute coronary syndrome during July-November 2017. All eligible adults more than 30 years were included in the study. After the administrative approval, data on patient characteristics, risk factors, laboratory investigations and therapy measures were extracted through structured proforma. Time to reach hospital after the onset of pain, time to thrombolysis and in-hospital all-cause mortality was considered to be the outcome measures. Results: Total of 100 patients were enrolled in the study where the majority of them were males (78%). Mean (SD) age of presentation with ACS was 57.2 (12.4) years. Median hour of presentation from the onset of chest pain to attending emergency OPD was 5 (3-7) Hours. The average median (Inter Quartile range) time delay between the onset of pain and thrombolysis was 5.6 (3.5-8.5) Hours which included 1.5 hours of delay after reaching the hospital. The median duration of hospital stay was 5 (3-6) days. The death rate among patients admitted and treated for ACS was 21 %( 13.4-30.2%). After the adjusted analysis factors namely diabetes mellitus [adjusted RR (95% CI): 4.6 (1.3-1.7)], need for inotropic support [adjusted RR (95% CI): 5.0 (1.4-1.8)] and advanced Killip grading [adjusted RR (95% CI): 2.1 (1.6-7.0)] were found to be independent predictors of in-hospital ACS mortality. Conclusions: More than 30% of ACS patients did not reach the treating facility within the golden period of six hours. In-hospital mortality was very high(21%) and factors such as diabetes, increased severity of diseases at the time of presentation are independently increased the risk of all-cause mortality among these patients.

Key Words: Coronary Artery Disease, Acute Coronary Syndrome, Myocardial infarction, time delay, STEMI, Non STEMI, in hospital mortality.