Dr F Aaysha Cader, Assistant Professor & Associate Consultant, Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2022 Oct;31(4):1057-1067.
The outcomes of acute coronary syndromes (ACS) vary internationally, given regional differences in patient co-morbidities, access to health care, interventional procedures and adherence to guideline-based management practices. This study aimed to identify the predictors of mortality from a large ACS registry of patients admitted to a tertiary care cardiac centre in Dhaka, Bangladesh. This was a hospital record based retrospective cross sectional observational study that included all patients presenting with ACS to Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh from January 2013 to December 2013. Data were collected from cardiac catheterization laboratory database and hospital discharge records. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0. A p value <0.05 was considered statistically significant. Ethical approval was obtained by Institutional Review Board of the hospital. A total of 1914 ACS patients were studied: 39.8% presented with ST-elevation myocardial infarction (STEMI), 39.7% with non-ST-elevation myocardial infarction (NSTEMI) and 20.5% with unstable angina (UA). There were 146 in-hospital deaths (7.6%). Mortality was highest among STEMI patients (10.5%), followed by NSTEMI (8.1%) and UA (1.03%). The mean age of expired patients was significantly higher than that of those who survived (64.82±12.14 years vs. 57.32±11.99 years; p<0.001). Male patients were 71.4%, with no significant gender differences observed between expired and surviving groups. Age >50 years {odds ratio (OR) 2.56, p=0.005}, chronic kidney disease (CKD) (OR 2.1, p<0.001), shock (OR 16.82, p<0.001), left ventricular failure (LVF) (OR 2.43, p<0.001) and STEMI (OR 1.92, p=0.002) were independent predictors of mortality among ACS patients. Although diabetes per se was not associated with mortality (OR 1.3; 95% CI=0.89-1.91; p=0.169), uncontrolled diabetes defined as HbA1c levels ≥7.5% had significant risk of mortality (OR 51.4, p<0.001). ACS patients who did not undergo angiography (OR 16.4; p<0.001) or PCI (OR 18.9; p<0.001) had greater risk of mortality. ACS patients complicated with shock, LVF, uncontrolled diabetes and CKD had increased risk of in-hospital mortality. Improved outcomes may be likely with prompt angiography and PCI during index admission. This study is a preliminary initiative, and prospective multi-centre registries with nation-wide involvement are warranted.
急性冠状动脉综合征（ACS）的结局在国际上有所不同，这是由于患者合并症、获得医疗保健、介入程序和遵循基于指南的管理实践方面存在区域性差异。本研究旨在确定孟加拉国达卡一家三级心脏中心的大型 ACS 注册患者的死亡预测因素。这是一项基于医院记录的回顾性横断面观察性研究，纳入了 2013 年 1 月至 2013 年 12 月期间因 ACS 入住孟加拉国达卡 Ibrahim 心脏医院和研究所的所有患者。数据来自心脏导管实验室数据库和医院出院记录。使用社会科学统计软件包（SPSS）版本 16.0 进行统计分析。p 值<0.05 被认为具有统计学意义。医院审查委员会获得了伦理批准。共研究了 1914 例 ACS 患者：39.8%表现为 ST 段抬高型心肌梗死（STEMI），39.7%为非 ST 段抬高型心肌梗死（NSTEMI），20.5%为不稳定型心绞痛（UA）。有 146 例院内死亡（7.6%）。STEMI 患者的死亡率最高（10.5%），其次是 NSTEMI（8.1%）和 UA（1.03%）。死亡患者的平均年龄明显高于存活患者（64.82±12.14 岁 vs. 57.32±11.99 岁；p<0.001）。男性患者占 71.4%，死亡组和存活组之间无明显性别差异。年龄>50 岁{优势比（OR）2.56，p=0.005}、慢性肾脏病（CKD）（OR 2.1，p<0.001）、休克（OR 16.82，p<0.001）、左心室衰竭（LVF）（OR 2.43，p<0.001）和 STEMI（OR 1.92，p=0.002）是 ACS 患者死亡的独立预测因素。尽管糖尿病本身与死亡率无关（OR 1.3；95%置信区间=0.89-1.91；p=0.169），但定义为 HbA1c 水平≥7.5%的未控制糖尿病具有显著的死亡风险（OR 51.4，p<0.001）。未接受血管造影（OR 16.4；p<0.001）或 PCI（OR 18.9；p<0.001）的 ACS 患者死亡风险更高。伴有休克、LVF、未控制糖尿病和 CKD 的 ACS 患者住院期间死亡率增加。在指数入院期间及时进行血管造影和 PCI 可能会改善预后。本研究是一项初步举措，需要开展有全国参与的多中心前瞻性登记研究。
