Clinical Characteristics, Risk Stratification, and Six-Month Post-Discharge Outcomes in Patients with Acute Coronary Syndrome at Sulaimani Cardiac Hospital
DOI:
https://doi.org/10.22317/jcms.v12i4.2226Keywords:
Acute Coronary Syndrome, GRACE Score, Ejection Fraction, Left Ventricular, Mortality, Patient Discharge, Follow-Up StudiesAbstract
Objectives: This study evaluated clinical characteristics, management, risk profile and six-month outcomes at Sulaimani Cardiac Hospital.
Methods: This ambispective study included 291 consecutive ACS admissions between 28 January and 31 December 2024. Index-admission variables were retrospectively abstracted from hospital records; post-discharge outcomes were prospectively ascertained by telephone at one and six months. Seventeen patients died in hospital. Six-month outcome status was ascertained in 246 of the 274 patients discharged alive.
Results: Of the 246 patients analysed, 166 were in the STEMI pathway (STEMI or new LBBB with a final acute-MI diagnosis), and 80 had UA/NSTEMI. At six months, 16 patients (6.5%) had died, 18 (7.3%) had recurrent ACS, 13 (5.3%) had heart-failure hospitalisation, and 2 (0.8%) had stroke/TIA. Repeat PCI was reported in 43 (17.5%) and CABG in 20 (8.1%). Recurrent ACS was more frequent in UA/NSTEMI than in the STEMI-pathway group (13.8% vs 4.2%; p=0.007); the difference in all-cause mortality was not statistically significant (2.5% vs 8.4%; p=0.077).
Conclusions: Six-month outcome status was ascertained in 89.8% of patients discharged alive. Recurrent ACS was more frequent after UA/NSTEMI than after a STEMI-pathway presentation. These descriptive findings should be interpreted in view of incomplete follow-up and telephone-based outcome ascertainment.
References
Byrne RA, Rossello X, Coughlan JJC, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. doi:10.1093/eurheartj/ehad191.
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-269. doi:10.1093/eurheartj/ehy462.
Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021. doi:10.1016/j.jacc.2020.11.010.
GBD 2015 Eastern Mediterranean Region Cardiovascular Disease Collaborators. Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study. Int J Public Health. 2018;63(Suppl 1):137-149. doi:10.1007/s00038-017-1012-3.
Al Suwaidi J. Acute coronary syndrome in the Middle East: the importance of registries for quality assessment and plans for improvement. Glob Cardiol Sci Pract. 2013;2013(1):2-4. doi:10.5339/gcsp.2013.2.
ACCESS Investigators. Management of acute coronary syndromes in developing countries: acute coronary events-a multinational survey of current management strategies. Am Heart J. 2011;162(5):852-859.e22. doi:10.1016/j.ahj.2011.07.029.
AlHabib KF, Sulaiman K, Al-Motarreb A, et al. Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Ann Saudi Med. 2012;32(1):9-18. doi:10.5144/0256-4947.2012.9.
Xavier D, Pais P, Devereaux PJ, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-1442. doi:10.1016/S0140-6736(08)60623-6.
Kassaian SE, Masoudkabir F, Sezavar SH, et al. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open. 2015;5(12):e007786. doi:10.1136/bmjopen-2015-007786.
Daida H, Miyauchi K, Ogawa H, et al. Management and two-year long-term clinical outcome of acute coronary syndrome in Japan: prevention of atherothrombotic incidents following ischemic coronary attack (PACIFIC) registry. Circ J. 2013;77(4):934-943. doi:10.1253/circj.CJ-13-0174.
Huo Y, Lee SWL, Sawhney JPS, et al. Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: findings from the EPICOR Asia study. Int J Cardiol. 2020;315:1-8. doi:10.1016/j.ijcard.2020.05.022.
Bahrani S, Sadeghi M, Teimouri-Jervekani Z, Nouri F, Sarrafzadegan N. Presentation, management and early mortality of patients with acute coronary syndrome in a large sample study of a Middle East country. Int J Prev Med. 2023;14:56. doi:10.4103/ijpvm.ijpvm_211_21.
Fox KAA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. doi:10.1136/bmjopen-2013-004425.
van der Sangen NMR, Azzahhafi J, Chan Pin Yin DRPP, et al. External validation of the GRACE risk score and the risk-treatment paradox in patients with acute coronary syndrome. Open Heart. 2022;9(1):e001984. doi:10.1136/openhrt-2022-001984.
Hicks KA, Mahaffey KW, Mehran R, et al. 2017 cardiovascular and stroke endpoint definitions for clinical trials. Circulation. 2018;137(9):961-972. doi:10.1161/CIRCULATIONAHA.117.033502.
Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi:10.1093/eurheartj/ehab484.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X.
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