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.