Acute coronary syndrome in young adults: the Thai ACS Registry.

BACKGROUND: There are few data regarding acute coronary syndrome (ACS) in young adults. ACS in young adults may have some characteristics that are different from those in older patients. OBJECTIVE: The purpose of the present study was to assess the frequency, risk factors, presenting symptoms, treatment, complications and in-hospital outcomes of young patients with ACS in Thailand compared with those of older patients. MATERIAL AND METHOD: From the Thai ACS registry database of 9,373 consecutive patients admitted to participating hospitals between August 1, 2002 and October 31, 2005, the authors divided patients into three age categories: < 45 years, 45-54 years and > 54 years. Risk factors, presenting symptoms, type ofACS, management, complications and in-hospital outcomes of the 3 age groups were analyzed. RESULTS: Young patients comprised of 5.8% (544 patients) of all ACS patients. Discharge diagnosis in the young group was ST segment elevation myocardial infarction (STEMI) in 67%, non-ST segment elevation myocardial infarction (NSTEMI) 20% and unstable angina 14%. The young patients were more likely to have an STEMI than their elder counterparts. Risk factors such as tobacco use and a family history were more frequent in the young patients, whereas diabetes and hypertension were less frequent. Importantly, 66% of the patients aged <45 years had a history of tobacco use. A higher percentage of the young patients underwent coronary angiography, percutaneous coronary intervention and received aspirin, thienopyridines, GP IIb/ IIIa antagonists, beta-blockers and statins. In STEMI patients, reperfusion therapy was given more frequently in the patients aged < 45 years. Younger patients had a lower in-hospital mortality rate, lower incidence of congestive heart failure and a shorter length of stay. Multivariable analysis of in-hospital mortality revealed that older age remained an independent predictor of death. CONCLUSION: In Thailand, 5.8% ofpatients with ACS are under the age of 45 years old. The frequency of risk factors in the young patients differs from those in their elderly counterparts. The current management and aggressive risk factor modification are quite good and the overall mortality is lower in young adults with ACS compared to their elder counterparts. Primary preventive measures aimed at preventing our youth from adopting tobacco use should be implemented nationally.

Predictors of in-hospital mortality in Thai STEMI patients: results from TACSR.

BACKGROUND: Clinical predictors of high-risk STEMI patients may guide physicians to the type of treatment, as high-risk patients need more aggressive treatment than low-risk patients. There was no previous registry of STEMI patients in Thailand. Objective: To determine the clinical predictors of in-hospital mortality in STEMI patients from the Thai ACS MATERIAL AND METHOD: A multi-center prospective nationwide Thai Acute Coronary Syndrome Registry (TACSR) was done between August 1, 2002 and October 31, 2005. The STEMI patients were registered to Thai ACS web site. Clinical and demographic characteristics, coronary risk factors, presenting symptoms, in-hospital treatments, reperfusion procedures and the patients' outcomes were recorded and analyzed. RESULTS: 3,836 STEMI patients were studied. The mean age was 62.2 +/- 12.8 years and 68% of the patients were male. The mortality rate of Thai STEMI patients was 17% (86.8% from cardiac causes) and the main cause of death was pumping failure (61.3%). The patients with older age > or = 75 years, patients with diabetes, shock, and cardiac arrhythmias had a higher mortality (29.4, 21.2, 43.4 and 37.24% respectively), while patients who underwent primary percutaneous coronary intervention (primary PCI) had a lower mortality rate (12.66%). Patients who received treatment with ASA, beta-blocker ACE inhibitor/ARB and statin had lower in-hospital mortality. CONCLUSION: The clinical predictors of high in-hospital mortality in STEMI patients from the TACSR were older age > or = 75 years, diabetes, shock, and cardiac arrhythmias. The treatments that can decrease the mortality were primary PCI, ASA, beta-blocker, ACE inhibitor/ARB and statin.

Impact of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction patients in Thailand.

BACKGROUND: Coronary heart disease is the leading cause of mortality and morbidity in men as well as in women. Women have their first cardiac event 6 to 10 years later than men do. Whereas, the cardiovascular death rates are declining in men, they remain constant in women. In cardiovascular studies with age limits, women are naturally the minority, amounting to < 40%. Objective: Determine the effect of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction (STEMI) patients. MATERIAL AND METHOD: This is a multicenter study including 13 government and 4 private institutions. Between August 1, 2002 and October 31, 2005, 3,836 consecutive patients with ST elevation myocardial infarction were enrolled. The patient characteristics, treatment, and hospital outcome were collected and validated. In-hospital management and outcomes were compared between men and women, without adjustment, with adjustment for age alone and with adjustment for age and other covariates by means of multivariate stepwise logistic regression analysis. In each model tested, gender was forced into the model, whereas other predictors were selected in a stepwise manner RESULTS: Women were 1,223 patients (31.9%) of all patients and were 8 years older than men (67.5 +/- 12.0 vs. 59.7 +/- 12.4 years). Women had a higher incidence of diabetes and hypertension (46.9% vs. 31.0%, p < 0.001 and 62.1% vs. 45.3%, p < 0.001). Smoking and family risk factor were found in men more than in women (17.5% vs. 52.5%, p < 0.001 and 7.4% vs. 11.2%, p< 0.001). Women presented more frequently with cardiac dyspnea and shock than men (35.3% vs. 22.2%, p < 0.001 and 21.5% vs. 13.8%, p < 0.001). There was no difference in time to admission between men and women. Beta blocker, statin, angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor inhibitor (ARB) were less frequently used in women. Coronary angiogram was performed less often in women and less abnormal angiogram were found (57.8% vs. 65.0%, p < 0.001 and 55.5% vs. 63.9%, p < 0.001). A lower percentage of women received thrombolytic therapy (28.1% vs. 31.4%, p = 0.039) as well as percutaneous coronary intervention (PCI) (39.0% vs. 48.5%, p < 0.001).Unadjusted in-hospital mortality was significantly higher in women than in men (23.6% vs. 13.9%, unadjusted OR (95% CI) 1.90 (1.60-2.26), p < 0.001). After adjustment of other covariables (age group> 75 years, hospital group (metropolitan, regional), chest pain, cardiac dyspnea, shock, post cardiac arrest, diabetes, hypertension, family history, smoking, dyslipidemia, refer time to admission < or = 12 hours (hour), aspirin, beta blocker calcium antagonist, statin, ACEI, ARB, nitrate, coronary angiogram, thrombolysis, PCI, coronary artery bypass grafting, congestive heart failure, arrhythmia, stroke, bleeding), the gender difference in-hospital mortality no longer existed (adjusted OR (95% CI) 1.03 (0.80-1.33), p = 0.814). The incidence of congestive heart failure as a complication was significantly higher in women than in men (55.6% vs. 38.7%, p < 0.001, adjusted OR (95% CI) 1.29 (1.08-1.54), p = 0.005). CONCLUSION: Women with acute ST elevation myocardial infarction were older and had a higher incidence of hypertension and diabetes than men. Women were less likely than men to undergo coronary angioplasty. Women in the authors' registry had a higher risk for in-hospital morbidity and mortality than men. Early and aggressive treatment might improve the clinical outcomes in women with STEMI.