Acute coronary syndrome in 1366 patients at Siriraj Hospital: clinical characteristics, management and in-hospital outcomes.

OBJECTIVE: To characterize the baseline characteristics, management and in-hospital outcomes of all patients admitted with acute coronary syndrome (ACS). MATERIAL AND METHOD: The present study is a prospective, observational study of all consecutive patients admitted with ACS. From August 1, 2002 through October 31, 2005, data from 1366 ACS patients were collected. RESULTS: The patients were classified according to the final discharge diagnosis as ST-segment elevation myocardial infarction (STEMI, 33.5%), non-ST-segment elevation myocardial infarction (NSTEMI, 47%) and unstable angina (UA, 19.5%). Approximately half of the patients were older than 65 years old. The STEMI patients were significantly younger and had a higher percentage of men than the NSTE-ACS patients. There was a very high prevalence of diabetes, hypertension and dyslipidemia in the patients. Only 60% of the STEMI patients received reperfusion therapy. Of these, primary percutaneous coronary intervention (PCI) was performed more frequently (35%) than thrombolytic therapy (24%). There were substantial delays in time to treatment. Median door to needle and door to balloon time were 135 and 130 minutes respectively. Half of the NSTEMI and UA patients underwent coronary angiography and about one-third had PCI or coronary artery bypass grafting in the same hospital admission. In-hospital mortality rate was high: STEMI 19%, NSTEMI 16% and UA 4%. CONCLUSION: The present study provides invaluable information regarding the spectrum of ACS in our country. Overall in-hospital mortality was higher than that reported from international registries. The present findings represent a significant opportunity for quality improvement in the care of patients with ACS and the implementation of preventive strategies for patients with and at risk for coronary artery disease.

Diabetes mellitus and non-ST elevation myocardial infarction in Thai ACS Registry.

OBJECTIVE: To describe differences in in-hospital morbidity and mortality, presenting characteristics and management practices of diabetic and non-diabetic patients with non-ST elevation myocardial infarction using data from Thai ACS registry. MATERIAL AND METHOD: Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. RESULTS: The present study consisted of 3,548 patients with non-ST elevation myocardial infarction from 17 hospitals in about a 3-year period. About 50% of the patients with diabetes were more often female, with a greater prevalence of hypertension and dyslipidemia. The diabetic group was at an increased risk for congestive heart failure (adjusted odds ratio 1.84) but not increased risk for cardiac arrhythmia, cardiac mortality, and in-hospital mortality. CONCLUSION: There was a very high prevalence of diabetes in non-ST elevation myocardial infarction from ThaiACS registry. These patients were at increased risk for congestive heart failure as index of hospitalization but were not at increased risk for in-hospital mortality when compared with patients without diabetes.

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.

Primary percutaneous transluminal coronary intervention compared with intravenous thrombolysis in patients with ST segment elevation myocardial infarction.

BACKGROUND: Primary percutaneous transluminal coronary intervention (PCI) and thrombolytic therapy (TT) are alternative means of achieving reperfusion in patients with acute ST segment elevation myocardial infarction (STEMI). OBJECTIVE: To compare the outcomes between both reperfusion strategies. The authors sought to compare in-hospital outcomes after PCI or TT for patients with acute STEMI. MATERIAL AND METHOD: From August 2002 through June 2004, data from all patients who received reperfusion therapy for acute STEMI were collected prospectively. The decision regarding type of reperfusion strategy was at the attending cardiologist's discretion. The patient's data on demographics, procedures, medications, and in-hospital outcomes were analyzed. RESULTS: From August 2002 through June 2004, 234 patients were admitted to the authors' institute with the diagnosis of acute STEMI. Of the 146 patients who received reperfusion therapy, 91 were treated with primary PCI and 55 received intravenous TT as the reperfusion modality. In the TT group, 51 (93%) patients received streptokinase and 11 (21.6%) underwent rescue angioplasty. The two groups had similar baseline characteristics. Both patient groups had frequent presence of diabetes (PCI 44.2% vs. TT 39.6%, p = 0. 6). Cardiogenic shock on admission was present in 11% of the PCI patients and 7.3% of the TT patients (p = ns). In-hospital mortality was not significantly different in the two groups (PCI 14.3% vs. TT 10. 9%, p = 0.56). In the TT group, there was a trend toward a higher rate of major bleeding (PCI 6.6% vs. TT 16.4%, p = 0.06) and stroke (PCI 2.2% vs. TT 7.3%, p = 0.13) complications without statistical significance. CONCLUSION: The present findings suggest that both PCI and TT are comparable alternative methods of reperfusion among STEMI patients in terms of in-hospital mortality. In certain subgroups that are at increased risk of bleeding or stroke, primary PCI may be the preferred treatment strategy.