Clinical and electrocardiographic profile of patients presenting with acute coronary syndrome in emergency department in a Tertiary Care Hospital.

Abstract

Objectives: To assess the clinical characteristics and diagnosis of ACS for timely, management and further prevention from coronary events. Study Design: Cross sectional study. Setting: Emergency Department (ED) of Punjab Institute of Cardiology (PIC) Lahore. Period: November 2017 to January 2018. Material & Methods: Included 170 diagnosed patients of ACS of both sexes presenting within approximately four hours of symptoms. At presentation ECG and initial blood samples were taken from all patients for base line and Troponin T estimation. All the patients included in the study were properly examined and complete history was taken. Blood samples of patients for diagnosis of NSTEMI were also drawn at 8hrs of arrival. The patients were categorized into STEMI, NSTEMI and UA on the basis of history, ECG and cardiac Troponin T. Results were analyzed statistically. A p-value ≤ 0.05 was considered statistically significant. Results: A total of 170 patients with established diagnosis of ACS were included. The mean age of the patients was 56 years. There was a very strong male predominance (81.76%). The major modifiable risk factors were hypertension (54.71%) and smoking (35.88%), followed by hyperlipidemia (35.29%) and diabetes (32.35%). A previous history of IHD in patients and family history of IHD were equally present (37.65%). A large proportion of patients belonged to middle class (54.12%) and lower (41.18%). Typical pain chest pain was present in 90% and majority of patients enrolled in this study had a diagnosis of myocardial infarction 77.05% and the remainder had unstable angina. We found a higher percentage of ST elevation MI in the patients with MI (84.73%), majority had anterior AMI. Of all patients, 1.77% expired during hospital stay. Conclusion: The majority of ACS patients in our country are male with STEMI. The major risk factors are hypertension, family history of IHD, smoking, hyperlipidemia and diabetes. 90% patients present with typical chest pain while remaining 10% atypical symptoms which must be of prime consideration to assess ACS.