Rashid Aamir, Purra Sameer, Kakroo Shahood A, Hafeez Imran, Lone Ajaz A, Rather Hilal
Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND.
Cureus. 2024 Apr 23;16(4):e58820. doi: 10.7759/cureus.58820. eCollection 2024 Apr.
The challenges posed by high altitude are particularly significant in terms of cardiovascular health. There are currently no data available on acute coronary syndrome (ACS) among Amarnath pilgrims. The objective of this study was to investigate the clinical and angiographic profiles of ACS among Amarnath pilgrims, focusing on demographic characteristics, risk factors, types of ACS, clinical presentation, angiographic findings, and in-hospital outcomes. By examining these aspects, we aimed to provide insights into the unique challenges faced by pilgrims during their spiritual journey and to identify potential strategies for improving the prevention and management of ACS in this population. Methods: This was a hospital-based, prospective, observational study that included patients who had participated in the pilgrimage and presented with ACS between 2022 and 2023. Results: Sixty patients were recruited for the study, with a mean age of 51.19 ± 11.17 years. Of these, 43 (71.7%) were male. Risk factors identified in the study included hypertension in 35 (58.3%), smoking in 23 (38.3%), diabetes mellitus in 18 (30%), and dyslipidemia in 25 (41.6%) patients. ST-elevation myocardial infarction (STEMI) was present in 46 (76.66%) patients, Anterior wall myocardial infarction (AWMI) occurred in 29 (48.3%), inferior wall myocardial infarction (IWMI) in 15 (25%), and high lateral wall myocardial infarction (HLWMI) in two (3.3%) patients. Of the 60 patients, 19 (31.6%) were in Killip class I, 16 (26.6%) were in class II, and 25 (41.6%) were in classes III or IV. The average time from the onset of symptoms to hospitalization was 7.6 ± 3.1 hours, significantly higher in those with Killip class III or IV (9.3 ± 3.6 vs. 5.4 ± 2.7 hours, p = 0.01). There were nine (15%) in-hospital deaths, and in the multivariate analysis, advanced Killip class (p = 0.04) and delays in hospitalization of more than six hours (p = 0.03) were found to be significant predictors of mortality.
In conclusion, 40% of patients presented in the advanced Killip class, and 15% experienced in-hospital mortality. The average time from the onset of symptoms to hospitalization was significantly higher for those categorized in the advanced Killip classes. Our study highlights a significant association between advanced Killip class, delay in hospitalization, and in-hospital mortality among Amarnath pilgrims with ACS, underscoring the importance of timely intervention. It is recommended that appropriate measures be taken to improve patient outcomes in these cases.
高海拔带来的挑战对心血管健康尤为显著。目前尚无关于阿玛纳特朝圣者中急性冠状动脉综合征（ACS）的数据。本研究的目的是调查阿玛纳特朝圣者中ACS的临床和血管造影特征，重点关注人口统计学特征、危险因素、ACS类型、临床表现、血管造影结果及住院结局。通过研究这些方面，我们旨在深入了解朝圣者在其精神之旅中面临的独特挑战，并确定改善该人群ACS预防和管理的潜在策略。
这是一项基于医院的前瞻性观察性研究，纳入了2022年至2023年间参加朝圣并出现ACS的患者。
该研究招募了60名患者，平均年龄为51.19±11.17岁。其中，43名（71.7%）为男性。研究中确定的危险因素包括35名（58.3%）患者患有高血压、23名（38.3%）患者吸烟、18名（30%）患者患有糖尿病以及25名（41.6%）患者患有血脂异常。46名（76.66%）患者为ST段抬高型心肌梗死（STEMI），29名（48.3%）患者发生前壁心肌梗死（AWMI），15名（25%）患者发生下壁心肌梗死（IWMI），2名（3.3%）患者发生高侧壁心肌梗死（HLWMI）。在60名患者中，19名（31.6%）处于Killip I级，16名（26.6%）处于II级，25名（41.6%）处于III级或IV级。从症状发作到住院的平均时间为7.6±3.1小时，Killip III级或IV级患者的这一平均时间显著更长（9.3±3.6小时对5.4±2.7小时，p=0.01）。有9名（15%）患者在住院期间死亡，多因素分析显示，高级Killip分级（p=0.04）和住院延迟超过6小时（p=0.03）是死亡率的显著预测因素。
总之，40%的患者处于高级Killip分级，15%的患者在住院期间死亡。高级Killip分级患者从症状发作到住院的平均时间显著更长。我们的研究强调了在患有ACS的阿玛纳特朝圣者中，高级Killip分级、住院延迟与住院死亡率之间存在显著关联，凸显了及时干预的重要性。建议针对这些情况采取适当措施以改善患者结局。
