Epidemiological profile and predictors of mortality in acute coronary syndrome: a prospective study

ABSTRACT

Background: India has shown a rising trend in the prevalence of coronary artery disease (CAD) in urban as well as in rural population. Acute coronary syndrome (ACS) is the main reason for the mortality in India. Study of risk factors and biomarkers is important to catch the diagnosis early in order to decrease the mortality. Objective was to study risk factors and brain natriuretic peptide (BNP), troponine I, and CKMB and their effect on outcome in ACS patients in tertiary hospital.Methods: One hundred and fifty ACS patients were studied in Emergency Department of Medicine, Nehru Hospital, BRD Medical College, Gorakhpur from January 2017 to December 2017. Data on age sex socioeconomic status, medical history, baseline clinical characteristics, time to reach hospital and treatment in hospital, along with biomarkers including BNP, Troponin Iand CKMB was estimated. Baseline ECG was obtained at admission and repeated at 12 -24 hours and every 24 hours thereafter. A 2D Echocardiogram was performed within initial 48-72 hours for analysis of LVEF and wall motion abnormalities.Results: Male (58.7%) preponderance was observed with mean age of 60.12±10.58 years. Most of the patients were from rural areas (87.3%) and had hypertension (44.7%). Chest pain was most common symptom (56%). Most of them had duration of symptoms for 6-12 hours (56%). NSTEMI, STEMI and unstable angina were equally distributed between the genders (p>0.05). Out of 150 patients, 15 (10%) were thrombolysed, 78.52% had RWMA. In-hospital mortality was higher; among the patients of age >75 years (38.5%) (p=0.008), male patient (12.5%) (p>0.05), rural patient (10.7%) (p>0.05), hypertensive patient (17.3%) (p>0.05), patients of Killip class IV (48.3%)(p=0.0001) and patients having severe LVD (33.3%) (p=0.0001). In-hospital mortality was 1.2% and 1.1% among those in whom beta blocker and ACE inhibitors was present (p>0.0001). BNP and CKMB was significantly higher among expired patients (1762.62±1444.89 vs 840.76±1294.82; p=0.001) similarly troponin I was significantly higher among expired patients (67.29±45.63 vs 43.99±41.73; p=0.006) than alive.Conclusions: ACS was more prevalent in male, living in fifth to sixth decade of life, had hypertension. STEMI was more common. Patients on ACE inhibitors and beta-blocker had better outcome. Mortality was higher in patients with Killip’s class IV, higher value of troponin I, age more than 75 years and had hypertension and dyslipidemia