Study on Epidemiological Profile, Clinical Profile, and Angiographic Patterns in Acute Coronary Syndrome Patients in a Tertiary Health Care Center in Haryana
Background: Cardiovascular diseases are the leading cause of death in India, with coronary artery disease (CAD) accounting for a majority of the deaths. There are few large registries on acute coronary syndrome (ACS) from India. Our aim is to study the clinical and epidemiological profile of ACS PATIENTS presenting to our institute, including their angiographic features. Methods: This hospital-based observational, single tertiary care center, prospective study was conducted on patients admitted in the Department of Cardiology at a tertiary care center in Haryana. The study included 400 patients aged greater than 18 years who were admitted with the diagnosis of ACS, and it was carried out for 1 year. The epidemiological profile, clinical history, risk factors, electrocardiogram findings, and angiographic pattern were studied and analyzed with appropriate statistical tools. Results: The mean age of the study population was 55.12 ± 11.78 years. Male and female ratio was 2.4:1. The majority of the patients came from rural background (80%); 24% of the patients were illiterate. Smoking was the most common risk factor (51.5%) in our study population followed by hypertension (40%) and diabetes (28%). Unstable angina was the most common type of ACS, which was found in 68.25% of patients. Premature CAD was found in 27.8% of patients and obstructive CAD was found in 63% of patients. Coronary angiography revealed that 39% had single vessel disease (SVD), 23.5% had double vessel disease (DVD), and 27.5% had triple vessel disease (TVD). LAD was more commonly involved, followed by RCA and LCX. Within the first 24 hours, 67% of patients sought medical assistance and only 38.5% received definitive treatment, suggesting a delay in seeking definitive treatment in our study population. Conclusion: The study suggests that unstable angina is the most common form of ACS in the study population, which is mostly of rural background with significant delay in seeking medical help. Smoking is the most common risk factor in the study population.
References
[1]
Zègre-Hemsey, J.K., Asafu-Adjei, J., Fernandez, A. and Brice, J. (2019) Characteristics of Prehospital Electrocardiogram Use in North Carolina Using a Novel Linkage of Emergency Medical Services and Emergency Department Data. PrehospitalEmergencyCare, 23, 772-779. https://doi.org/10.1080/10903127.2019.1597230
[2]
Huffman, M.D., Prabhakaran, D., Osmond, C., Fall, C.H.D., Tandon, N., Lakshmy, R., et al. (2011) Incidence of Cardiovascular Risk Factors in an Indian Urban Cohort. JournaloftheAmericanCollegeofCardiology, 57, 1765-1774. https://doi.org/10.1016/j.jacc.2010.09.083
[3]
Xavier, D., Pais, P., Devereaux, P., Xie, C., Prabhakaran, D., Reddy, K.S., et al. (2008) Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE): A Prospective Analysis of Registry Data. TheLancet, 371, 1435-1442. https://doi.org/10.1016/s0140-6736(08)60623-6
[4]
Mohanan, P.P., Mathew, R., Harikrishnan, S., Krishnan, M.N., Zachariah, G., Joseph, J., et al. (2012) Presentation, Management, and Outcomes of 25 748 Acute Coronary Syndrome Admissions in Kerala, India: Results from the Kerala ACS Registry. EuropeanHeartJournal, 34, 121-129. https://doi.org/10.1093/eurheartj/ehs219
[5]
Negi, P.C., Merwaha, R., Panday, D., Chauhan, V. and Guleri, R. (2016) Multicenter HP ACS Registry. IndianHeartJournal, 68, 118-127. https://doi.org/10.1016/j.ihj.2015.07.027
[6]
Sharma, R., Bhairappa, S., Prasad, S. and Manjunath, C. (2014) Clinical Characteristics, Angiographic Profile and in Hospital Mortality in Acute Coronary Syndrome Patients in South Indian Population. HeartIndia, 2, 65-69. https://doi.org/10.4103/2321-449x.140228
[7]
Krishnan, M.N., Zachariah, G., Venugopal, K., Mohanan, P.P., Harikrishnan, S., Sanjay, G., et al. (2016) Prevalence of Coronary Artery Disease and Its Risk Factors in Kerala, South India: A Community-Based Cross-Sectional Study. BMCCardiovascularDisorders, 16, Article No. 12. https://doi.org/10.1186/s12872-016-0189-3
[8]
Prabhakaran, D., Jeemon, P. and Roy, A. (2016) Cardiovascular Diseases in India. Circulation, 133, 1605-1620. https://doi.org/10.1161/circulationaha.114.008729
[9]
Sreeniwas Kumar, A. and Sinha, N. (2020) Cardiovascular Disease in India: A 360 Degree Overview. MedicalJournalArmedForcesIndia, 76, 1-3. https://doi.org/10.1016/j.mjafi.2019.12.005
[10]
Ahmad, N. (2005) Is Coronary Heart Disease Rising in India? A Systematic Review Based on ECG Defined Coronary Heart Disease. Heart, 91, 719-725. https://doi.org/10.1136/hrt.2003.031047
[11]
Thygesen, K., Alpert, J.S., Jaffe, A.S., Chaitman, B.R., Bax, J.J., Morrow, D.A., et al. (2018) Fourth Universal Definition of Myocardial Infarction (2018). Circulation, 138, e618-e651. https://doi.org/10.1161/cir.0000000000000617
[12]
Amsterdam, E.A., Wenger, N.K., Brindis, R.G., Casey, D.E., Ganiats, T.G., Holmes, D.R., et al. (2014) 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes. JournaloftheAmericanCollegeofCardiology, 64, e139-e228. https://doi.org/10.1016/j.jacc.2014.09.017
[13]
Physical Activity Guidelines Advisory Committee (2008) Physical Activity Guidelines Advisory Committee Report, 2008. US Department of Health and Human Services.
[14]
American Diabetes Association (2020) 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021. DiabetesCare, 44, S15-S33. https://doi.org/10.2337/dc21-s002
[15]
Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Collins, K.J., Dennison Himmelfarb, C., DePalma, S.M., Gidding, S., Jamerson, K.A., Jones, D.W. and MacLaughlin, E.J. (2017) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71, e127-e248.
[16]
Knapper, J.T., Khosa, F., Blaha, M.J., Lebeis, T.A., Kay, J., Sandesara, P.B., et al. (2015) Coronary Calcium Scoring for Long-Term Mortality Prediction in Patients with and without a Family History of Coronary Disease. Heart, 102, 204-208. https://doi.org/10.1136/heartjnl-2015-308429
[17]
Khoja, A., Andraweera, P.H., Lassi, Z.S., Zheng, M., Pathirana, M.M., Ali, A., et al. (2021) Risk Factors for Premature Coronary Artery Disease (PCAD) in Adults: A Systematic Review Protocol. F1000Research, 10, 1228. https://doi.org/10.12688/f1000research.74926.1
[18]
National Institutes of Health (1998) Clinical Guidelines for the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obesity Research, 6, 51S-209S.
[19]
Pentapati, S.S.K. and Debnath, D.J. (2023) Updated BG Prasad’s Classification for the Year 2022. JournalofFamilyMedicine and Primary Care, 12, 189-190. https://doi.org/10.4103/jfmpc.jfmpc_1478_22
[20]
(2024) Indian Standard Classification of Education. Gov.in. https://www.education.gov.in/sites/upload_files/mhrd/files/statistics-new/InSCED2014.pdf
[21]
Lee, K.L., Woodlief, L.H., Topol, E.J., Weaver, W.D., Betriu, A., Col, J., et al. (1995) Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction. Circulation, 91, 1659-1668. https://doi.org/10.1161/01.cir.91.6.1659
[22]
Bhatt, D.L. (2015) Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease. Elsevier.
[23]
Levine, G.N., Bates, E.R., Blankenship, J.C., Bailey, S.R., Bittl, J.A., Cercek, B., Chambers, C.E., Ellis, S.G., Guyton, R.A., Hollenberg, S.M. and Khot, U.N. (2011) ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Journal of the American College of Cardiology, 58, e44-e122.
[24]
Gensini, G.G. (1983) A More Meaningful Scoring System for Determining the Severity of Coronary Heart Disease. TheAmericanJournalofCardiology, 51, 606. https://doi.org/10.1016/s0002-9149(83)80105-2
[25]
Yokokawa, T., Yoshihisa, A., Kiko, T., Shimizu, T., Misaka, T., Yamaki, T., et al. (2020) Residual Gensini Score Is Associated with Long-Term Cardiac Mortality in Patients with Heart Failure after Percutaneous Coronary Intervention. CirculationReports, 2, 89-94. https://doi.org/10.1253/circrep.cr-19-0121
[26]
O’Gara, P.T., Kushner, F.G., Ascheim, D.D., Casey, D.E., Chung, M.K., De Lemos, J.A., Ettinger, S.M., Fang, J.C., Fesmire, F.M., Franklin, B.A. and Granger, C.B. (2013) ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 61, e78-e140.
[27]
Sharma, S., Rashid, A., Ashraf, M., Ismail, M., Tanvir, M., Sharma, P., et al. (2017) Clinical Profile of Acute Coronary Syndromes (ACS) in North Indian Population: A Prospective Tertiary Care Based Hospital Study. AnnalsofInternationalmedicalandDentalResearch, 2, 50-53. https://doi.org/10.21276/aimdr.2017.3.5.me11
[28]
Lal Bansal, B. and P J, A. (2016) Study of Risk Factors, Clinical Profiles and Angiographic Patterns in Patients of Coronary Artery Disease in a Tertiary Care Centre in Chhattisgarh. JournalofEvolutionofMedicalandDentalSciences, 5, 7638-7648. https://doi.org/10.14260/jemds/2016/1724
[29]
Nayak, M., Patel, D., Chaturvedi, A. and Shah, A. (2022) Recent Trends in the Pattern and Long-Term Management Strategy of Patients Diagnosed with Acute Coronary Syndrome in India: An Observational Study. InternationalJournalofResearchinMedicalSciences, 10, 2144-2149. https://doi.org/10.18203/2320-6012.ijrms20222373
[30]
Adil, M., Iqbal, M.A., Hassan, Z., Ullah, M., Ahmed, S. and Khan, M.S. (2023) Clinical Profile, Angio-Graphic Profile and Outcome in Acute Coronary Syndrome Patients in a Tertiary Care Hospital. JournalofPostgraduateMedicalInstitute, 37, 109-113.
[31]
Ahsan, M.M., Shahidul Haque, S.M., Sultana, S., Sarker, A.C., Hossain, M.S., Siddiqui, M.K., Jamil, A.B. and Faruq, M.F. (2023) Clinical Characteristics, Risk Factors and Angiographic Profile of Patients Undergoing Coronary Angiography in a Tertiary Care Hospital. CardiologyandCardiovascularMedicine, 7, 1-4.
[32]
Deshmukh, P.P., Singh, M.M., Deshpande, M.A. and Rajput, A.S. (2019) Clinical and Angiographic Profile of Very Young Adults Presenting with First Acute Myocardial Infarction: Data from a Tertiary Care Center in Central India. IndianHeartJournal, 71, 418-421. https://doi.org/10.1016/j.ihj.2019.12.004
[33]
Bashandy, M., Abd Elgalil, H. and Abou Elhassan, H.E. (2019) Epidemiological and Clinical Profile of Acute Coronary Syndrome of Egyptian Patients Admitted to the Coronary Care Unit, Al-Azhar University Hospital, New Damietta. TheScientificJournalofAl-AzharMedicalFaculty, Girls, 3, 625-634. https://doi.org/10.4103/sjamf.sjamf_74_19
[34]
Khan, H.U., Khan, M.U., Noor, M.M., Hayat, U. and Alam, M.A. (2014) Coronary Artery Disease Pattern: A Comparison among Different Age Groups. JournalofAyubMedicalCollegeAbbottabad, 26, 466-469.
[35]
Sharma, Y.P., Santosh Vemuri, K., Bootla, D., Kanabar, K., Pruthvi, C.R., Kaur, N., et al. (2021) Epidemiological Profile, Management and Outcomes of Patients with Acute Coronary Syndrome: Single Centre Experience from a Tertiary Care Hospital in North India. IndianHeartJournal, 73, 174-179. https://doi.org/10.1016/j.ihj.2020.11.149
[36]
Gupta, M.D., MP, G., Kategari, A., Batra, V., Gupta, P., Bansal, A., et al. (2020) Epidemiological Profile and Management Patterns of Acute Myocardial Infarction in Very Young Patients from a Tertiary Care Center. IndianHeartJournal, 72, 32-39. https://doi.org/10.1016/j.ihj.2020.03.003
[37]
Sidhu, N.S., Rangaiah, S.K.K., Ramesh, D., Veerappa, K. and Manjunath, C.N. (2020) Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study from Urban India. ClinicalMedicineInsights: Cardiology, 14, 1-7. https://doi.org/10.1177/1179546820918897
[38]
Mirza, A.J., Taha, A.Y. and Khdhir, B.R. (2018) Risk Factors for Acute Coronary Syndrome in Patients Below the Age of 40 Years. TheEgyptianHeartJournal, 70, 233-235. https://doi.org/10.1016/j.ehj.2018.05.005
[39]
Santos, R.C.D.O.D., Goulart, A.C., Kisukuri, A.L.X., Brandão, R.M., Sitnik, D., Staniak, H.L., et al. (2016) Time-to-Treatment of Acute Coronary Syndrome and First Contact in the ERICO Study. ArquivosBrasileirosdeCardiologia, 107, 323-330. https://doi.org/10.5935/abc.20160138
[40]
Kumar, A. and Cannon, C.P. (2009) Acute Coronary Syndromes: Diagnosis and Management, Part I. MayoClinicProceedings, 84, 917-938. https://doi.org/10.4065/84.10.917
[41]
Revaiah, P.C., Vemuri, K.S., Vijayvergiya, R., Bahl, A., Gupta, A., Bootla, D., et al. (2021) Epidemiological and Clinical Profile, Management and Outcomes of Young Patients (≤40 Years) with Acute Coronary Syndrome: A Single Tertiary Care Center Study. IndianHeartJournal, 73, 295-300. https://doi.org/10.1016/j.ihj.2021.01.015
[42]
Raju, V. (2023) Clinical and Angiographic Profile in Non-St Elevation Acute Coronary Syndrome (NSTE-ACS) and Chronic Stable Angina: A Tertiary Care Centre-Based Cohort Study from Southern Indian Population. Cureus, 15, e38369. https://doi.org/10.7759/cureus.38369