ST-Segment Elevated Acute Myocardial Infarction: Changing Profile Over Last 24 Years
Trinath Kumar Mishra1, Biswajit Das2
1Professor and HOD.
Insights
This study analyzed 45,122 acute ST-segment elevated myocardial infarction (STEMI) patients in India, revealing younger onset and multiple risk factors. Improved treatments have significantly reduced STEMI mortality over time.
Area of Science:
- Cardiology and Cardiovascular Diseases
- Public Health and Epidemiology
Background:
- Coronary artery disease (CAD) is a growing epidemic in India, characterized by early onset and numerous risk factors.
- Understanding the profile of acute ST-segment elevated myocardial infarction (STEMI) is crucial for public health initiatives.
Purpose of the Study:
- To comprehensively analyze the demographic profile, risk factors, clinical presentation, treatments, and outcomes of acute STEMI patients in India.
- To track the changing trends and profile of STEMI over a 24-year period.
Main Methods:
- A cross-sectional study involving 45,122 acute STEMI patients admitted between March 1990 and March 2014.
- Data collection included detailed clinical history, physical examination, laboratory parameters, therapeutic interventions, and in-hospital outcomes.
Main Results:
- STEMI patients presented at a mean age of 56.34 years, with 82.48% being male. Key risk factors included urban residency, lower education, middle/low socioeconomic status, unemployment, lack of exercise, poor diet, smoking, obesity, diabetes, hypertension, hyperlipidemia, and family history.
- Anterior wall STEMI was most common (56.78%). Less than half presented within 12 hours, and only 0.8% within 1 hour. Complications included CHF (34.7%), cardiogenic shock (8.65%), reinfarction (6.5%), arrhythmia (59.2%), and a 10.57% mortality rate.
- Mortality decreased significantly from 13.9% (1990-2000) to 8.8% (2000-2014), correlating with increased use of beta-blockers, ACE inhibitors/ARBs, aldosterone antagonists, and reperfusion strategies.
Conclusions:
- The study highlights the significant burden of STEMI in India, with a distinct demographic and risk factor profile.
- Advancements in medical management, including pharmacotherapy and reperfusion strategies, have demonstrably reduced STEMI-related mortality.
Background:
Coronary artery disease (CAD) is rising in epidemic proportions with India not being an exception. CAD in Indian scenario has its onset at a younger age with multitude of risk factors.
Objective:
This study was carried out to obtain complete information about demographic profile, risk factors, clinical scenario, therapeutic modalities, natural course, outcome and changing profile of acute ST-segment elevated myocardial infarction (STEMI) patients.
Methods:
This cross-sectional study was conducted in 45,122 acute STEMI patients admitted 1st March 1990 to 1st March 2014. A predefined performa was completed in every patient with detailed clinical history, physical examination, laboratory and investigation parameters, therapeutic interventions and inhospital outcome.
Results:
Our population cohort presented with STEMI at age of 56.34±11.88 years with 82.48% male. Urban residency (64.35%), lower level of education (61.03%), middle and low socioeconomic status (81.01%), unemployment (56.47%), lack of exercise (78.80%) and poor dietary pattern including low intake of fruits and vegetables (58.80%) were pivotal players. Smoking was prevalent in 48.80% cases, with overweight and obesity (51.11%), diabetes mellitus (27.34%), hypertension (38.85%), hyperlipidemia (28.15%), alcoholism (28.80%) and family history (16.66%). Our population had mildly elevated LDL (101.4±33.38 mg/dl), low HDL (36.6±10.7 mg.dl) and high TC/HDL ratio (4.05±1.36). Majority harbored (52.06%) two or more risk factors, while in 16.60% no conventional risk factors were identified. Anterior wall STEMI (56.78%) far exceeded the inferior wall (37.55%). Less than half (47.77%) presented within the window period of 12 hours while only 0.8% of patients availed the golden period of 1 hour. 50.27% presented in Killip Class II or beyond. Angiography revealed single vessel disease (46.76%) with LAD involvement being most common (58.85%). Thrombolytic therapy was provided in 38.95% and primary PCI in 2.1%. Complications in the form of CHF (34.7%), cardiogenic shock (8.65%), reinfarction (6.5%), arrhythmia (59.2%) and mortality (10.57%) were seen. Mortality decreased from 13.9% (from 1990-2000) to 8.8% (2000-2014).
Conclusions:
With recent increased use of β-blocker, ACEI/ARB, aldosterone antagonist and reperfusion strategy, we have brought down the mortality to lower level.
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