Acute coronary syndrome (ACS) registry--leading the charge for National Cardiovascular Disease (NCVD) Database
S P Chin1, S Jeyaindran, R Azhari
1International Medical University, No 126, Jalan 19/155B, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
Insights
Acute coronary syndrome (ACS) affects 3422 Malaysian patients, with smoking a key STEMI risk factor. Treatments like PCI reduced mortality, but age and Killip Class remain critical determinants.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Coronary artery disease (CAD) is a leading global non-communicable disease, progressing from fatty streaks to arterial narrowing and myocardial perfusion impairment.
- Atherosclerotic plaque rupture leads to acute coronary syndrome (ACS), encompassing ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI), and unstable angina (UA), a major cause of death in Malaysia and worldwide.
- Understanding the burden of disease, available resources, and treatment strategies for ACS is crucial for national health initiatives.
Purpose of the Study:
- To analyze data from the Acute Coronary Syndrome (ACS) registry, the flagship of the National Cardiovascular Disease Database (NCVD) in Malaysia.
- To assess the burden of disease, treatment patterns, and outcomes for ACS patients in Malaysia based on 2006 data.
- To identify key determinants of mortality and disparities in treatment among ACS patient demographics.
Main Methods:
- Analysis of data collected in 2006 from 3422 patients admitted with ACS to 12 tertiary cardiac centers and general hospitals across nine Malaysian states.
- Data collection was facilitated by the National Heart Association, National Heart Foundation, Clinical Research Centre, and the Ministry of Health, Malaysia.
- Statistical analysis to determine patient demographics, risk factors, medication utilization, treatment interventions (thrombolysis, PCI), and mortality rates.
Main Results:
- The mean age of ACS patients was 59 years, with active smoking identified as the most consistent risk factor for STEMI.
- Thirty-day mortality rates were 11% for STEMI, 8% for NSTEMI, and 4% for UA.
- Thrombolysis (STEMI only) and Percutaneous Coronary Intervention (PCI) for non-ST elevation MI and unstable angina significantly reduced in-hospital and 30-day mortality by nearly 50%. Age and Killip Class were the strongest predictors of mortality. Women constituted 25% of the cohort but received thrombolysis or PCI less frequently on admission.
Conclusions:
- The findings highlight the significant burden of ACS in Malaysia and the effectiveness of reperfusion therapies in reducing mortality.
- Age and Killip Class are critical factors influencing ACS patient outcomes, necessitating tailored management strategies.
- There is a potential disparity in treatment, with fewer women receiving timely interventions like thrombolysis or PCI, warranting further investigation and targeted interventions.
Abstract:
Coronary artery disease is one of the most rampant non-communicable diseases in the world. It begins indolently as a fatty streak in the lining of the artery that soon progresses to narrow the coronary arteries and impair myocardial perfusion. Often the atherosclerotic plaque ruptures and causes sudden thrombotic occlusion and acute ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI) or unstable angina (UA). This phenomenon is called acute coronary syndrome (ACS) and is the leading cause of death not only in Malaysia but also globally. In order for us to tackle this threat to the health of our nation we must arm ourselves with reliable and accurate information to assess current burden of disease resources available and success of current strategies. The acute coronary syndrome (ACS) registry is the flagship of the National Cardiovascular Disease Database (NCVD) and is the result of the dedicated and untiring efforts of doctors and nurses in both public and private medical institutions and hospitals around the country, ably guided and supported by the National Heart Association, the National Heart Foundation, the Clinical Research Centre and the Ministry of Health of Malaysia. Analyses of data collected throughout 2006 from 3422 patients with ACS admitted to the 12 tertiary cardiac centres and general hospitals spanning nine states in Malaysia in this first report has already revealed surprising results. Mean age of patients was 59 years while the most consistent risk factor for STEMI was active smoking. Utilization of medications was high generally. Thirty-day mortality for STEMI was 11%, for NSTEMI 8% and UA 4%. Thrombolysis (for STEMI only) reduced in-hospital and 30-day mortality by nearly 50%. Percutaneous coronary intervention or PCI also reduced 30-day mortality for patients with non-ST elevation MI and unstable angina. The strongest determinants of mortality appears to be Killip Class and age of the patient. Fewer women received thrombolysis or underwent PCI on same admission although women make up 25% of the cohort.
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