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...

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Vydané v:	European heart journal Ročník 34; číslo 2; s. 121
Hlavní autori:	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
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England 01.01.2013
Predmet:	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
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Abstract	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.
AbstractList	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.AIMSThere 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.METHODS AND RESULTSWe 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.CONCLUSIONThese data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care. 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.
Author	Abraham, Mathew Joseph, Jhony Eapen, Koshy Zachariah, Geevar Huffman, Mark D Mathew, Rony Jacob, Sonny Menon, Jaideep Krishnan, Mangalath Narayanan Prabhakaran, Dorairaj Thomas, Manoj Harikrishnan, Sadasivan Mohanan, Padinhare Purayil
Author_xml	– sequence: 1 givenname: Padinhare Purayil surname: Mohanan fullname: Mohanan, Padinhare Purayil email: drppmohanan@gmail.com organization: Department of Cardiology, Westfort Hi-Tech Hospital, Ltd, P.B. No. 930, Punkunnam, Thrissur 680 002, Kerala, India. drppmohanan@gmail.com – sequence: 2 givenname: Rony surname: Mathew fullname: Mathew, Rony – sequence: 3 givenname: Sadasivan surname: Harikrishnan fullname: Harikrishnan, Sadasivan – sequence: 4 givenname: Mangalath Narayanan surname: Krishnan fullname: Krishnan, Mangalath Narayanan – sequence: 5 givenname: Geevar surname: Zachariah fullname: Zachariah, Geevar – sequence: 6 givenname: Jhony surname: Joseph fullname: Joseph, Jhony – sequence: 7 givenname: Koshy surname: Eapen fullname: Eapen, Koshy – sequence: 8 givenname: Mathew surname: Abraham fullname: Abraham, Mathew – sequence: 9 givenname: Jaideep surname: Menon fullname: Menon, Jaideep – sequence: 10 givenname: Manoj surname: Thomas fullname: Thomas, Manoj – sequence: 11 givenname: Sonny surname: Jacob fullname: Jacob, Sonny – sequence: 12 givenname: Mark D surname: Huffman fullname: Huffman, Mark D – sequence: 13 givenname: Dorairaj surname: Prabhakaran fullname: Prabhakaran, Dorairaj
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/22961945$$D View this record in MEDLINE/PubMed
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PublicationYear	2013
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References_xml	– reference: 16198838 - J Am Coll Cardiol. 2005 Oct 4;46(7):1242-8 – reference: 22093201 - Am Heart J. 2011 Nov;162(5):852-859.e22 – reference: 16908490 - Eur Heart J. 2006 Oct;27(19):2285-93 – reference: 19249422 - Am Heart J. 2009 Mar;157(3):509-516.e1 – reference: 14581255 - Arch Intern Med. 2003 Oct 27;163(19):2345-53 – reference: 19004139 - Natl Med J India. 2008 May-Jun;21(3):107-11 – reference: 16302038 - Bull World Health Organ. 2005 Nov;83(11):820-9 – reference: 11274933 - Am J Cardiol. 2001 Apr 1;87(7):819-22 – reference: 20633817 - J Am Coll Cardiol. 2010 Jul 20;56(4):254-63 – reference: 16639050 - JAMA. 2006 Apr 26;295(16):1912-20 – reference: 12127921 - Eur Heart J. 2002 Aug;23(15):1190-201 – reference: 21521849 - JAMA. 2011 Apr 27;305(16):1677-84 – reference: 12127920 - Eur Heart J. 2002 Aug;23(15):1177-89 – reference: 16196178 - Indian Heart J. 2005 May-Jun;57(3):217-25 – reference: 19339045 - Lancet. 2009 Apr 18;373(9672):1341-51 – reference: 18440425 - Lancet. 2008 Apr 26;371(9622):1435-42 – reference: 18984927 - Indian Heart J. 2006 Jan-Feb;58(1):28-33 – reference: 21695127 - PLoS One. 2011;6(6):e20821 – reference: 23070025 - Eur Heart J. 2013 Jan;34(2):83-5
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Snippet	There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a...
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SubjectTerms	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
Title	Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry
URI	https://www.ncbi.nlm.nih.gov/pubmed/22961945 https://www.proquest.com/docview/1285463733
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