Quality of care of adult patients with ST-Elevation Myocardial Infarction (STEMI) at the emergency room of a tertiary hospital in the Philippines

@#<p style="text-align: justify;"><strong>Introduction.</strong> Coronary artery disease (CAD) remains a significant public health problem worldwide and in the Philippines. Adherence to guideline-directed therapy improves the quality of care (QOC).</p><p style="text-align: justify;"><strong>Objective.</strong> We aimed to evaluate the QOC initially received by ST-Elevation Myocardial Infarction (STEMI) patients at our Emergency Room (ER), based on compliance to 2014 PHA CAD guidelines recommendations.</p><p style="text-align: justify;"><strong>Methods.</strong> We reviewed the charts of adult patients with STEMI admitted at the ER who were not previously managed in a different hospital. The primary outcome was QOC assessed through quality indicators (QI) based on class I and IIa recommendations in the PHA CAD guidelines.</p><p style="text-align: justify;"><strong>Results.</strong> Of the 29 patients included, all had ECG done upon admission, but only four were done within 10 minutes (QI: 13.79%). All eligible patients received antiplatelets (QI: 100%). Six eligible patients (QI: 100%) received nitrates, and four eligible patients (QI: 100%) received morphine. Of 16 eligible patients, only six were reperfused within the recommended 12 hours of ischemia (QI: 37.5%), two by thrombolysis and four by the primary percutaneous coronary intervention (PCI).</p><p style="text-align: justify;"><strong>Conclusion.</strong> The timely performance of initial ECG and reperfusion need improvement. Suitable performance measures for the provision of nitrates and morphine to eligible patients were met. Investigating intrinsic and extrinsic factors that lead to the time delays observed are also recommended.</p>

Clinical Profile and Major Adverse Cardiovascular Outcomes in Patients who Underwent Coronary Revascularization for Left Main Coronary Artery Disease and Left Main Equivalent Coronary Artery Disease in a Tertiary Hospital

@#BACKGROUND: Percutaneous coronary intervention (PCI) for left main (LMCA) coronary artery disease (CAD) was found to be non-inferior and had similar major adverse cardiovascular events (MACE) to coronary artery bypass grafting (CABG). In the local setting, the clinical profile and MACE of patients who underwent either revascularization are, however, unknown. OBJECTIVES: To determine the clinical profile and in-hospital MACE of patients who underwent revascularization (PCI or CABG) for LMCA and left main equivalent CAD. METHODS: This is a prospective descriptive study. Clinical profile and in-hospital, 30-days and 90-days post revascularization MACE were determined. RESULTS: Thirty-seven (37) adults were included. Most were males, diabetics, dyslipidemics, smokers, with previous cardiovascular events and premature CAD. Hypertension was significantly prevalent in the CABG group (PCI=62.50% vs CABG=90.48%, p=0.04). Patients who underwent CABG mostly presented with stable angina (p=0.0453). The majority of the PCI (68.75%) was done as an emergent/urgent procedure, with clear indications for PCI (i.e. STEMI). In-hospital all-cause mortality was significantly higher in the PCI group (PCI=50% vs CABG=0%, p<<0.05). CONCLUSION: Patients with LMCA and left main equivalent CAD were mostly males and had traditional CAD risk factors. In-hospital mortality was significantly higher among the PCI group; however, those who underwent PCI were unstable and unlikely to be good surgical candidates for CABG.

Apolipoprotein levels in patients with Acute Coronary Syndrome (LIPAS): A pilot study

Introduction@#Lowering levels of low-density lipoprotein cholesterol (LDL-C) are proven to reduce cardiovascular risk. However, some individuals experience acute coronary events despite normal LDL-C levels. Recent studies have focused on modifiable lipoprotein targets, such as apolipoprotein B (apo-B) and apolipoprotein A-1 (apo A-1) and lipoprotein (a), as targets for therapy. Apo-B is the primary apolipoprotein of LDL-C representing total number of atherogenic particles. Apolipoprotein A-1 is the major component of HDL complex. This study will determine the prevalence of elevated apo-B and low apo A-1 among adult Filipinos with acute coronary syndrome (ACS).@*Methods@#This is a cross-sectional study involving 95 patients with ACS admitted in a tertiary hospital from November 2015 to May 2016. Levels of apo-B, apoA-1, lipoprotein (a), total cholesterol, triglyceride, LDL-C, and high-density lipoprotein cholesterol (HDL-C) were measured within 24 hours upon admission.@*Results@#Forty-eight (48%) percent of patients was diagnosed with Non ST-Elevation-ACS, 39% with ST-Elevation myocardial infarction (STEMI) and 13% with unstable angina.Thirtytwo (32%) percent were on low- to high-intensity statin treatment. The mean LDL-C, non-HDL-C, and HDL-C levels were 109 mg/dL, 135 mg/dL, and 36.89 mg/dL, respectively. The prevalence of elevated apo-B (mean=103.79 mg/ dL; target:<80 mg/dL) was 82%, while that of low apo A-1 (mean=119 mg/dL; target: >120 mg/dL for males, >140 mg/dL for females) was 63%. Lipoprotein (a) levels are high (mean = 48.51 nmol/L; normal:<35 nmol/L) in 42% of patients. Among those on statin therapy, the mean LDL-C was 85 mg/dl, but the mean apo B and lipoprotein (a) levels were elevated at 87.57 mg/dL and 41 nmol/L, respectively.@*Conclusion@#Elevated levels of apo B and lipoprotein (a) and low level of apo A-1 are highly prevalent in patients with ACS. Apo-B and lipoprotein (a) levels are likewise elevated among patients with normal LDL levels.