Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry

There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. We prospectively collected data...

Full description

Saved in:
Bibliographic Details
Published in:European heart journal Vol. 34; no. 2; p. 121
Main Authors: Mohanan, Padinhare Purayil, Mathew, Rony, Harikrishnan, Sadasivan, Krishnan, Mangalath Narayanan, Zachariah, Geevar, Joseph, Jhony, Eapen, Koshy, Abraham, Mathew, Menon, Jaideep, Thomas, Manoj, Jacob, Sonny, Huffman, Mark D, Prabhakaran, Dorairaj
Format: Journal Article
Language:English
Published: England 01.01.2013
Subjects:
Acute Coronary Syndrome - mortality
Acute Coronary Syndrome - therapy
Adult
Aged
Female
Fibrinolytic Agents - therapeutic use
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
India - epidemiology
Male
Middle Aged
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
Registries
Treatment Outcome
India
ISSN:1522-9645, 1522-9645
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE. These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1522-9645
1522-9645
DOI:10.1093/eurheartj/ehs219