Ramakrishnakumar, S (2009) Pattern of presentation and management of acute ST-segment elevation myocardial infarction to a tertiary care centre in a district capital in South India. Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND : Cardiovascular disease (CVD) is the leading cause of death worldwide and by 2010, 60% of world’s heart disease is expected to occur in India. The prevalence of diabetes and obesity has increased. Rates of primary percutaneous coronary intervention (PCI) have increased in western population. Mortality rates from STEMI are declining worldwide. We sought to study the pattern of presentation and management of patients presenting with acute STEMI to a tertiary care centre in a district capital in South India. METHODS : 150 consecutive patients presenting with acute STEMI to a tertiary care centre were enrolled. The demographic, socioeconomic, risk factor, clinical and laboratory profile of patients presenting with STEMI were recorded. The reperfusion strategy, use of guideline based acute medical therapy, in-hospital and 30 day outcomes were recorded for these patients. RESULTS : The mean age of study population was 57 ± 12 years. There were 117(78%) males and 33(22%) females. 84(56%) belonged to the middle class, 20(13.3%) and 46(30.7%) belonged to the upper and lower socioeconomic class respectively. The median pre-hospital delay was 4 hours. The median door-to-needle time was 45 minutes. The median door-to balloon time was 92 minutes. 73(48.7%) had diabetes, 64(42.7%) had hypertension, 51(34%) were smokers. The mean body mass index was 23.9 ± 2.8. The mean ejection fraction was 45 ± 9%. 76(50.7%) had anterior wall myocardial infarction and 68(45.3%) had inferior wall myocardial infarction. 130 (86.7%) underwent thrombolysis and 11(7.3%) underwent primary PCI. Streptokinase was the thrombolytic agent used in 124(95.4%) and tenecteplase in the rest. 89(59.3%) had >50% ST segment resolution post reperfusion. 28(18.7%) underwent coronary angiography during index hospitalization. Acute pharmacotherapy was widely used: Aspirin (98.7%), clopidogrel (97.3%), beta-blocker (88%), Angiotensin converting enzyme inhibitors (ACEI) (88.7%) and statins (94%). The in-hospital outcomes were death (12%), reinfarction (0.7%), recurrent angina (8%), arrhythmia (7.3%), LV systolic dysfunction (60.7%), stroke (1.3%), cardiogenic shock (3.3%), rescue PCI (5.3%), adjunct PCI (2.7%). The mean duration of hospital stay was 2.6 ± 2 days. The 30 day outcomes were death (0.7%0, reinfarction (2.7%0, recurrent angina (12%), and heart failure (11.3%). CONCLUSION : Patients presenting with STEMI are younger in comparison to western population. The proportion of women presenting with STEMI and prevalence of diabetes mellitus has increased. Women have significantly higher prevalence of diabetes than men. The pre-hospital delay is longer than Western population. Thrombolysis is the most commonly used reperfusion therapy. In-hospital mortality rates are declining but still higher than the western population. Use of guideline based prescription of acute medical therapy has increased.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Management ; acute ST-Segment Elevation Myocardial Infarction ; STEMI ; Tertiary Care Centre ; South India. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 10 Jul 2017 22:29 |
| Last Modified: | 10 Jul 2017 22:32 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1352 |
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