Abstract
BackgroundThere is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information.MethodsWe enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of all-cause death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE.ResultsA total of 601 patients, mean age 51.6 ± 10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8 ± 2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI 1.64–13.23).ConclusionsA high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.
Highlights
There is a paucity of data regarding acute phase major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh
Acute coronary syndrome is among the leading causes of morbidity and mortality globally [1], but, while the incidence and mortality rates are declining in most developed nations, they are on the rise in developing countries [2, 3]
Metabolic, and physiological risk factors of coronary artery disease are prevalent in the Bangladesh population [21, 22]. In light of this transition, and considering the paucity of in-hospital and 30-day MACE data in urban locations in Bangladesh, we aimed to determine MACE rates in the acute phase post-STEMI for evidencebased guidance to inform the mobilization of resources for therapeutic strategies in STEMI
Summary
There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. ST-segment elevation myocardial infarction (STEMI) is the most common acute manifestation. In economically disadvantaged areas like Bangladesh, the prevalence of coronary artery disease and STEMI remains mostly unknown, and only small scale epidemiological surveys provide evidence of its increase [11]. Most studies of post-STEMI outcomes focus on the acute phase, inhospital and 30 days post-discharge, after the index event [13, 14]. A literature search produced only a single study from Bangladesh describing post-STEMI outcomes as a composite of major adverse cardiac events (MACE) in a rural setting [15]
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