Effect of un-fractionated heparin and low molecular weight heparin on hospital mortality in patients with non ST elevation acute coronary syndrome (ACS).

BACKGROUND: The Thai ACS registry is a multi-center prospective registration that describes the epidemiology, management practices and in-hospital outcomes of patients with acute coronary syndromes. OBJECTIVE: Study the registry difference in hospital outcomes about cardiac death and length of stay between low molecular weight heparin (LMWH) and un-fractionated heparin (UFH). MATERIAL AND METHOD: This is an observational descriptive study. The authors collected data from the database of the Thai ACS registry. RESULTS: There were 233 of 3963 cases (5.9%) with cardiac death in the present study. Cardiac death in the non-ST elevated myocardial infraction (NSTEMI) group was larger than in the UA group (7.6% vs. 2.4%, p-value < 0.001). The heparin group had more cardiac death than the LMWH group (9.3% vs. 5.2%, p-value < 0.001). NSTEMI with heparin treatment had more cardiac deaths than LMWH treatment (11.8% vs. 6.8%, odd ratio 1.8). UA with heparin treatment had more cardiac deaths than LMWH treatment (4.0% vs. 2.0%, odd ratio 2.0). NSTEMI had a longer length of stay than UA (56.9% vs. 44.7%, p-value = 0.001). The heparin group had a longer stay than LMWH (58.8% vs. 51.7%, p-value < 0.001). CONCLUSION: Low molecular weight heparin had benefit over un-fractionated heparin in reduction of hospital mortality and length of stay in both unstable angina and non-ST elevation myocardial infarction.

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.

Implications of diabetes mellitus in patients with STEMI: data from Thai ACS Registry.

BACKGROUND: Data exist on the community-based perspective on the relation of diabetes mellitus (DM) and acute ST elevation myocardial infarction (STEMI) worldwide but no data is available in Thailand. MATERIAL AND METHOD: The Thai Acute Coronary Syndrome Registry (TACSR) is an observational study of patients hospitalized with ACS at 17 hospitals in different regions of Thailand. The present sub-study sample consisted of 3,725 patients with STEMI in a 3-year period. RESULTS: Nearly 40% (37.15%) of them had DM who were older predominantly women, with a greater prevalence of co-morbidities and fewer current smokers. Patients with DM who developed STEMI were at increased risk for heart failure, arrhythmia, bleeding and death. These differences remained after adjustment for potential confounding prognostic factors. CONCLUSION: A considerable proportion of patients with STEMI have DM. This proportion is higher than any other studies published. Diabetic patients who developed STEMI are also at increased risk for adverse outcomes including, heart failure, arrhythmia, bleeding and death compared to patients without DM.