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

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.