Short-term mortality and complications in ST elevation myocardial infarction--the Heart Hospital experience
V Achari1, Satya Prakash, Arun Kumar Sinha
1Patna Medical College, Patna.
Insights
This study found a 12.41% in-hospital mortality rate for acute ST-elevation myocardial infarction in India. While comparable to Western data, late thrombolysis and low revascularization rates highlight areas for improvement in acute myocardial infarction care.
Area of Science:
- Cardiology
- Public Health
Background:
- Acute myocardial infarction (AMI) mortality has decreased globally.
- Limited Indian data exists on in-hospital mortality for ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To determine the in-hospital mortality rate of STEMI patients at an Indian tertiary cardiac center.
- To analyze event rates including reinfarction, recurrent angina, and heart failure.
Main Methods:
- A consecutive series of 862 STEMI patients admitted between June 2003 and July 2006 were analyzed.
- Data collected included patient demographics, risk factors, infarction location, treatment received, and in-hospital outcomes.
Main Results:
- The in-hospital mortality rate for STEMI was 12.41%.
- Common risk factors included hypertension (54.29%), diabetes (44.55%), and smoking/tobacco use (48.14%).
- Only 40.14% received thrombolytic therapy, often late, with a mean symptom onset to admission time of 29.2 hours.
Conclusions:
- The in-hospital mortality rate for STEMI in this Indian cohort is comparable to Western reports.
- Low and delayed revascularization rates (thrombolysis or PTCA) are significant concerns.
- Further research and improved access to timely interventions are crucial for reducing STEMI mortality in India.
Abstract:
The mortality rate of acute myocardial infarction has declined considerably in the past three decades. In view of paucity of literature from different centres from India on this issue, the present study was undertaken to determine the in-hospital mortality with acute ST segment elevation myocardial infarction presenting to a tertiary care cardiac centre in India. Consecutive patients (n=862) with the diagnosis of acute ST segment elevation myocardial infarction admitted in Heart Hospital, Patna between June 2003 and July 2006 were included in this study. The in-hospital mortality and event rates (reinfarction, recurrent angina and heart failure) were analysed. The mean age of study population was 56 +/- 13 years. There were 690 males (80.05%) and 172 females (19.95%); 468 patients (54.29%) had hypertension, 384 patients (44.55%) were diabetic, 415 (48.14%) were smokers/tobacco chewers and 154 patients (17.86%) had past history of myocardial infarction. Anterior wall infarction was present in 435 patients (50.46%), 408 patients (47.33%) had inferior wall infarction, 115 patients (13.34%) had associated right ventricular or posterior wall infarction and 19 (2.20%) had antero-inferior infarction; 346 patients (40.14%) received thrombolytic therapy while the other patients were not thrombolysed due to various reasons (usually late arrival). The mean duration between symptom onset and hospital admission was 29.2. +/- 10.8 hours in the entire group (8.6 +/- 2.8 hours in the thrombolysed group). Of the total 862 patients, 107 patients (12.41%) died during in-hospital stay while 755 patients were discharged from the hospital in stable condition after a mean stay of 7.1 +/- 1.8 days. The in-hospital mortality rate of acute ST segment elevation myocardial infarction in this study was 12.41%, which is comparable to reports from the west. However the revascularisation rate (thrombolysis or PTCA) remained low and most patients received thrombolysis late.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:21Myocarditis I: Introduction
01:30Introduction Cardiac Emergencies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations