Department of Cardiology, Westfort Hi-Tech Hospital, Ltd, P.B. No. 930, Punkunnam, Thrissur 680 002, Kerala, India.
Eur Heart J. 2013 Jan;34(2):121-9. doi: 10.1093/eurheartj/ehs219. Epub 2012 Sep 7.
There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India.
We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE.
These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.
目前关于印度急性冠状动脉综合征(ACS)入院患者的临床表现、治疗和结局的当代数据有限。本研究旨在建立一个前瞻性登记系统,以解决印度喀拉拉邦 ACS 管理方面的治疗和卫生系统差距。
我们前瞻性地收集了 2007 年至 2009 年期间来自喀拉拉邦 125 家医院的 25748 例连续 ACS 入院患者的数据。我们评估了入院时的临床表现、管理以及院内死亡率和主要不良心血管事件(MACE)的数据。我们创建了随机效应多变量回归模型,以评估预测结果的因素,同时考虑混杂因素。入院时的平均(标准差)年龄为 60(12)岁,不同 ACS 类型之间无差异[ST 段抬高型心肌梗死(STEMI)=37%;非 ST 段抬高型心肌梗死(NSTEMI)=31%;不稳定型心绞痛=32%]。院内抗血小板药物使用率>90%。溶栓治疗在 STEMI、NSTEMI 和不稳定型心绞痛入院患者中的使用率分别为 41%、19%和 11%。STEMI 患者的经皮冠状动脉介入治疗率略高。出院时药物治疗率存在差异,且普遍不理想(<80%)。STEMI 患者的院内死亡率和 MACE 发生率最高(分别为 8.2%和 10.3%)。校正后,STEMI 诊断(与不稳定型心绞痛相比)[比值比(95%置信区间)=4.06(2.36,7.00)]、症状至门时间>6 h [比值比=2.29(1.73,3.02)]和溶栓治疗不恰当[比值比=1.33(0.92,1.91)]与较高的院内死亡率相关,而门至溶栓时间<30 min [比值比=0.44(0.27,0.72)]与较低的死亡率相关。MACE 风险也呈现出类似的趋势。
这些数据代表了印度最大的 ACS 登记系统,表明在 ACS 治疗方面有改进的机会。