Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
S Afr Med J. 2023 Apr 4;113(4):24-25.
Tygerberg Hospital (TBH) is a tertiary level hospital in the Western Cape of South Africa that serves a large, low to middle income population with centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region, despite a high burden of communicable diseases, including people living with human immunodeficiency virus (PLHIV). Objectives. We sought to describe the incidence of ST elevation myocardial infarction (STEMI) and high-risk non-ST elevation ACS (HR-NSTEACS) in the TBH referral network, describe the in-hospital and 30-day mortality of these patients and identify important high-risk population characteristics. Methods. The Tygerberg Acute Coronary Syndrome Registry (TRACS) database is an ongoing prospective study that enrols all STEMI and HR-NSTEACS patients in the TBH referral network. All patients older than 18 years presenting with STEMI or HR-NSTEACS were treated in accordance with current European Society of Cardiology (ESC) guidelines and were included prospectively over a 9-month surveillance period. A waiver of consent was granted to include patients who demised prior to giving informed consent. Collected data included a demographic profile, risk factors for cardiovascular disease, in hospital therapy and 30-day mortality. Results. A total of 586 patients were enrolled, with a male predominance (64.5%) and incidence rates of STEMI and HR-NSTEACS of 14.7/100 000 and 15.6/100 000 respectively. The mean patient age was 58.1 years and STEMI patients tended to be younger than HR-NSTEACS patients (56yrs vs.58yrs; p=0.01). Cardiovascular risk factors were prevalent overall, but hypertension (79.8%vs.68.3%; p<0.01), and pre-existing coronary artery disease (29%vs.7%; p=0.03) were more prevalent in the HR-NSTEACS group. HIV was present in 12.6% of patients tested, similar to the background population rate. The overall 30-day all-cause mortality was 6.1% with an in-hospital mortality rate of 3.9%. The 30-day mortality rates were similar for STEMI (6.7%) and HR-NSTEACS (5.7%; p=0.83). PLHIV did not impact mortality. Conclusions. The use of a guideline-based approach to treating ACS in a low-middle income countries (LMIC) setting yields mortality rates comparable to high income countries. However, the lower-than-expected incidence rates of both STEMI and NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and relatively high proportion of STEMI, suggests potential under recording of ischemic heart disease (IHD) in the region. The rate and outcomes of coronary artery disease (CAD) in PLHIV was similar to people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.
泰格伯格医院（TBH）是南非西开普省的一家三级医院，为人口众多的中低收入人群提供集中的高级心脏护理。急性冠状动脉综合征（ACS）仍然是该地区的一个重要死亡原因，尽管传染病负担很重，包括艾滋病毒感染者（PLHIV）。目的。我们旨在描述 TBH 转诊网络中 ST 段抬高型心肌梗死（STEMI）和高危非 ST 段抬高型 ACS（HR-NSTEACS）的发生率，描述这些患者的住院和 30 天死亡率，并确定重要的高危人群特征。方法。泰格伯格急性冠状动脉综合征登记处（TRACS）数据库是一项正在进行的前瞻性研究，纳入了 TBH 转诊网络中所有 STEMI 和 HR-NSTEACS 患者。所有年龄大于 18 岁的 STEMI 或 HR-NSTEACS 患者均按照欧洲心脏病学会（ESC）目前的指南进行治疗，并在 9 个月的监测期间前瞻性纳入。对于在给予知情同意之前死亡的患者，授予了同意豁免。收集的数据包括人口统计学特征、心血管疾病的危险因素、院内治疗和 30 天死亡率。结果。共纳入 586 例患者，男性占优势（64.5%），STEMI 和 HR-NSTEACS 的发生率分别为 14.7/100000 和 15.6/100000。患者平均年龄为 58.1 岁，STEMI 患者比 HR-NSTEACS 患者年轻（56 岁 vs.58 岁；p=0.01）。总体上心血管危险因素普遍存在，但高血压（79.8% vs.68.3%；p<0.01）和预先存在的冠状动脉疾病（29% vs.7%；p=0.03）在 HR-NSTEACS 组中更为常见。接受检测的患者中有 12.6%为 HIV 阳性，与背景人群的阳性率相似。总 30 天全因死亡率为 6.1%，住院死亡率为 3.9%。STEMI（6.7%）和 HR-NSTEACS（5.7%；p=0.83）的 30 天死亡率相似。PLHIV 并未影响死亡率。结论。在中低收入国家（LMIC）采用基于指南的方法治疗 ACS 可产生与高收入国家相当的死亡率。然而，在一个相对年轻的人群中，传统心血管危险因素的患病率较高，STEMI 的比例相对较高，STEMI 和 NSTEACS 的发病率均低于预期，这表明该地区可能存在缺血性心脏病（IHD）记录不足的情况。PLHIV 的冠心病（CAD）发生率和结局与未感染 HIV 的人相似，这表明传统危险因素仍然是该地区 CAD 结局的驱动因素。
