Abstract 9151: Presentation, Management, and Outcomes of 25,748 Acute Coronary Syndrome Admissions in Kerala, India: Results from the Kerala ACS Registry

Abstract

Introduction: There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. The Cardiological Society of India - Kerala Chapter developed a prospective ACS registry to address this gap. Hypothesis: We hypothesized that patients presenting with STEMI would be younger, have lower education levels, be more likely to undergo PCI, and be more likely to die during index hospitalization and 30-day follow-up than patients with non-STEMI and unstable angina. Methods: We prospectively collected data on 25,748 consecutive ACS admissions from 2007-2009 in 125 hospitals in Kerala, India. Results: The Table describes the differences among STEMI (37%), non-STEMI (31%), and unstable angina (32%) patient presentation, management, and outcomes. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types, but unstable angina admissions were more likely to be men and have a prior history of diabetes and MI than other ACS types. In-hospital aspirin and clopidogrel rates were high (>90%) and similar across ACS types, whereas in-hospital heparin and beta-blocker rates were lower overall (<75%) and more commonly used in non-STEMI and unstable angina admissions compared with STEMI admissions. Angiography rates were similar across the 3 groups, and PCI rates were slightly higher in STEMI (13%) compared with non-STEMI (12%) and unstable angina (11%). Discharge medication rates were variable and generally suboptimal (<80%). In-hospital and 30-day death rates were highest for STEMI admissions (8.2% and 14.6%, respectively). Presentation, management, and outcomes differ from data from a US-based cohort such as the NCDR ACTION Registry-Get-With-The-Guidelines. Conclusions: In conclusion, these data represent the largest ACS registry in India to date and will serve as the baseline for future ACS quality improvement efforts in Kerala.