Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain
Taysir S Garadah1, Khalid Bin Thani2, Leena Sulibech3
1College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Insights
This study identified key risk factors for Acute Coronary Syndrome (ACS) in Bahrain, finding diabetes mellitus and high GRACE scores significantly predict in-hospital mortality and cardiac events. These findings highlight crucial areas for intervention in ACS patient care.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- Limited prior data on Acute Coronary Syndrome (ACS) risk factors and short-term mortality in Bahrain.
- Need for understanding local patient profiles and outcomes.
Purpose of the Study:
- To identify clinical risk profiles of ACS patients in Bahrain.
- To determine incidence, presentation patterns, and predictors of in-hospital outcomes.
Main Methods:
- Prospective observational study of ACS patients over 12 months.
- Comparison of risk factor incidence with age- and gender-matched non-cardiac patients.
- Logistic regression analysis to predict poor outcomes using variables like age, BMI, GRACE score, diabetes, hypertension, creatinine, and heart rate.
Main Results:
- 635 ACS patients enrolled; mean age 61.3 years, 65.6% male.
- In-hospital mortality rates: STEMI (5.1%), NSTEMI (3.1%), UA (2.5%).
- Predictors of mortality/events: GRACE score >170 (OR 2.8), Diabetes Mellitus (OR 3.1), SBP >180 mmHg (OR 2.2), positive troponin (OR 2.2), and HR >90 bpm (OR 2.1).
Conclusions:
- STEMI patients were younger but had higher in-hospital mortality compared to NSTEMI and UA.
- Diabetes Mellitus, high GRACE score, systolic hypertension, elevated troponin, and rapid heart rate are significant predictors of adverse outcomes in ACS.
Background:
Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before.
Aim:
In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission.
Methods:
Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG.
Results:
Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation.
Conclusion:
Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.
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