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. 2009 May:57:377-83.

The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala

K J Raihanathul Misiriya  1 , N Sudhayakumar, S Abdul Khadar, Raju George, V L Jayaprakasht, Joseph M Pappachan
Affiliations
  • PMID: 19634283

The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala

K J Raihanathul Misiriya et al. J Assoc Physicians India. 2009 May.

Abstract

Background: The clinical profile and the mortality rate among patients with acute coronary syndromes (ACS) are not well studied in Kerala.

Aims: To determine the clinical characteristics, mortality rate and possible risk factors for high mortality among patients with ACS.

Settings and design: Retrospective study conducted at Kottayam Medical College, a large teaching hospital.

Patients and methods: Successive cases presenting with ACS to the coronary-care unit between May 2005 and December 2006 were included. Cases were grouped into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction/unstable angina (NSTEMI/UA) for the purpose of analysis. Statistical analysis : Univariate analysis using chi square test and unpaired t test.

Results: Among 1865 patients treated for ACS, 1359 (72.9%) were males. One hundred fifty (8.04%) died during treatment. One thousand forty-four (56%) had STEMI and 376 of them (36%) occurred between 12 pm and 6 pm. One hundred twenty-five patients (11.97%) with STEMI died. Significantly higher mortality rates were observed among females (22.8% vs. 9%; p<0.001), cases with inferior wall infarctions (17% vs. 7%; p=0.001) and cases not receiving thrombolysis (15% vs. 10%, p=0.005). Diabetes mellitus (OR=1.96), age >75 years (OR=2.42) and higher Killip class at admission were associated with high mortality. Eight hundred twenty five cases (44%) had NSTEMI/UA. Twenty five of them (3.05%) died. Higher proportion of cases with NSTEMI/UA in comparison to STEMI had hypertension (43% vs. 29.02%; p<0.001) and diabetes mellitus (41.05% vs. 23.95%; p<0.001), and had been females (34.96% vs. 21%; p=0.002). Mortality rate was higher among females (4.5% vs. 2.2%; p=0.016)

Conclusions: The mortality rates in ACS and STEMI remain high in this hospital. Subjects with diabetes mellitus, females and elderly individuals had greater mortality rates and are high risk groups.

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