National Heart Institute Acute Coronary Syndrome Registry
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- Category: Vol. 80, June 2012
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National Heart Institute Acute Coronary Syndrome Registry,SAMEH SHAHEEN, AHMED MAGDI, IMAN ESMAT, AHMED MOHANNAD and WAEL EL KILANY
Abstract
Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary artery disease [1], registries and surveys have the potential to define the 'gaps' between evidence and practice as well as implementation of guidelines [2].
Aim of the Work: To assess the application of a newly designed registry among Egyptian patients with ACS and to compare the results with those of other international registries.
Methods: The study included 401 patients having acute coronary syndrome admitted to the National Heart Institute CCU over 6 months from January 2007 to June 2007 that were subjected to full history & clinical examination, 12 leads, ECG, and echocardiography. Patients were classified according to the ECG at presentation into ACS with ST elevation, ACS
Abbreviations:
ACS = Acute Coronary Syndrome NHI = National Heart Institute HTN = Hypertension
DM = Diabetes Mellitus
ER = Emergency Room
MI = Myocardial infraction
CABG = Coronary artery Bypass Graft.
PCI = Percutaneous Coronary Intervention.
CCS = Canadian Cardiovascular Society Classification RBBB = Right Bundle Branch Block
ABP = Arterial Blood Pressure. MR = Mitral Regurgitation VSD = Ventricular Septal Defect.
TR = Tricuspid Regurgitation
LV EF = Left Ventricular Ejection Fraction.
LVEDD = Left ventricular end diastolic diameter
LVESD = Left ventricular end systolic diameter
FS = Fraction shortening
SV = Stroke volume
EDV = End diastolic volume
ESV = End systolic volume
CHF = Congestive Heart Failure. LVH = Left ventricular Hypertrophy. IHD = Ischemic Heart Disease
without ST Elevation, and ACS with undetermined ECG changes. Patients were managed according to the ACC/AHA guidelines 2004 for STEMI & update 2002 for unstable angina and NSTEMI, In hospital MACE; death, re-infarction, target vessel revascularization and rrhythmias were assessed.
Results: ACS with ST elevation was the most common presentation (59.1 %), age of our study population ranges from 18 to 88 years old (54.5±11.9 years). Most of patients were males (79%), smoking was the most significant risk factor (61 %) followed by Hypertension (55%). The main presenting symptom was typical anginal chest pain (91.5%).
Coronary angiography was performed in 40% of our study population with higher incidence among patients who had ACS with undetermined ECG changes (44.12%), however reperfusion by PCI was undertaken in a higher percentage of patients with ACS with ST elevation (30.38%).
In patients diagnosed as STEMI (267 patients), 65.5% of the patients received thrombolysis “Streptokinase”, while 12.4% were referred for primary PCI.
Heart failure was the most prevalent in hospital compli-cation, Atrial fibrillation was the most common occurring arrhythmia.
Conclusions: Smoking & hypertension are significant risk factors among Egyptian patients. The use of invasive strategy was restricted to the most critical patients; this was because of financial causes.