Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

Gangapatnam Subramanyam,Gautam Samir,Guruprasad Sogunuru,Lekhjung Thapa,Madhav Ghimire,Mani Prasad Gautam,Raju Paudel,Ramila Shilpakar,Usha Ghimire

doi:10.31729/jnma.1897

Gangapatnam Subramanyam, Gautam Samir + Show 7 more

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https://doi.org/10.31729/jnma.1897

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Abstract

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

Highlights

Acute coronary syndrome is the major leading cause for coronary care unit admission
Acute Coronary Syndrome (ACS), a common condition for Intensive Care Unit (ICU) admission, refers to a spectrum of clinical presentations ranging from those for ST-segment Elevation Myocardial Infarction (STEMI) to presentations found in Non–ST-segment Elevation Myocardial Infarction (NSTEMI) or in unstable angina (UA)
This was in contrast to a study by Jafary et al,[10] from Pakistan, where they had reported the mean age of 52.5±10.8 years and more than three-quarters of these study subjects were below 60 years and only 22.5% were over 60 years of age

Summary

Introduction

Acute coronary syndrome is the major leading cause for coronary care unit admission. Correspondence: Dr Mani Prasad Gautam, Department of Gautam et al Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Care Centre: The Spectrum and Coronary Risk Factors. Acute Coronary Syndrome (ACS), a common condition for Intensive Care Unit (ICU) admission, refers to a spectrum of clinical presentations ranging from those for ST-segment Elevation Myocardial Infarction (STEMI) to presentations found in Non–ST-segment Elevation Myocardial Infarction (NSTEMI) or in unstable angina (UA). We have tried to fill this gap from a hospital-based study and have attempted to estimate the patterns of various categories of ACS in ICU admitted subjects and analyze the associated CHD risk factors

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