RISK FACTOR PROFILE AND IN-HOSPITAL OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME: A PROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL
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Keywords
Acute Coronary Syndrome; Risk Factors; Myocardial Infarction; Diabetes Mellitus; Hypertension; Cardiovascular Disease; In-Hospital Outcome
Abstract
Background: Acute Coronary Syndrome (ACS) is a major contributor to cardiovascular morbidity and mortality worldwide. The increasing prevalence of cardiovascular risk factors in developing countries, particularly in India, has led to a substantial rise in the burden of ACS. Identification of risk factors and assessment of clinical outcomes are essential for improving preventive and therapeutic strategies.
Objectives: To evaluate the risk factor profile of patients admitted with Acute Coronary Syndrome and to assess their in-hospital clinical outcomes at a tertiary care hospital.
Methods: A prospective observational study was conducted in the Department of Medicine and Coronary Care Unit of a tertiary care hospital from February 2011 to June 2011. A total of 42 consecutive patients diagnosed with ACS, including ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina, were enrolled. Demographic characteristics, cardiovascular risk factors, clinical presentation, and in-hospital outcomes were recorded using a structured case record form. Data were analyzed using SPSS version 17.0. Associations between risk factors and adverse outcomes were assessed using appropriate statistical tests, with p<0.05 considered statistically significant.
Results: The mean age of the study population was 56.4 ± 11.2 years, and 73.8% of patients were male. Hypertension (57.1%), smoking/tobacco use (52.4%), diabetes mellitus (42.9%), and dyslipidemia (38.1%) were the most common risk factors. STEMI was the predominant clinical presentation, accounting for 59.5% of cases, followed by NSTEMI (23.8%) and unstable angina (16.7%). Most patients recovered without major complications. Heart failure was the most frequent complication (16.7%), followed by arrhythmias (11.9%) and cardiogenic shock (7.1%). The in-hospital mortality rate was 7.1%. Diabetes mellitus demonstrated a significant association with adverse in-hospital outcomes (p=0.02).
Conclusion: Traditional cardiovascular risk factors were highly prevalent among patients with ACS. Hypertension, smoking, diabetes mellitus, and dyslipidemia constituted the major risk factors. Diabetes mellitus was associated with poorer short-term outcomes. Strengthening preventive measures and optimizing management of modifiable risk factors may improve outcomes and reduce the burden of ACS.
References
2. WHO G. Global status report on noncommunicable diseases 2010.
3. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The lancet. 2004 Sep 11;364(9438):937-52.
4. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey Jr DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions .... Circulation. 2007 Aug 14;116(7):e148-304.
5. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. Journal of the cardiometabolic syndrome. 2007 Sep;2(4):267-75.
6. Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian heart journal. 2008 Mar 1;60(2 Suppl B):B4-18.
7. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, Gupta R, Joshi P, Kerkar P, Thanikachalam S, Haridas KK. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. The Lancet. 2008 Apr 26;371(9622):1435-42.
8. Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L, Mohan BM, Pandav CS, Ahmed FU, Joshi PP, Meera R. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bulletin of the world health organization. 2006 Jun;84(6):461-9.
9. Fox KA, Goodman SG, Klein WF, Brieger D, Steg PG, Dabbous O, Avezum A. Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE). European heart journal. 2002 Aug 1;23(15):1177-89.
10. World Health Organization. Prevention of Cardiovascular Disease. pocket guidelines for assessment and management of cardiovascular risk. africa: Who/Ish Cardiovascular Risk Prediction Charts for the African Region. World Health Organization; 2007.
11. Fox KA, Carruthers KF, Dunbar DR, Graham C, Manning JR, De Raedt H, Buysschaert I, Lambrechts D, Van de Werf F. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK–Belgian Study). European heart journal. 2010 Nov 1;31(22):2755-64.
12. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A. ESC guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Revista espanola de cardiologia. 2009 Mar 1;62(3):293.
13. Writing Group Members, Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010 Feb 23;121(7):e46-215.
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Dr. Bishwa Bhusan Bharti
Assistant Professor, Department of Cardiology, J.J.M. Medical College, Davangere, Karnataka, India.
Dr. Manoj Kumar Murli
Assistant Professor, Department of General Medicine, Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital, Kishanganj, Bihar, India. (
