Acute coronary syndrome in the elderly: the Malaysian National Cardiovascular Disease Database- Acute Coronary Syndrome registry

Zuhdi, Ahmad Syadi Mahmood; Ahmad, Wan Azman Wan; Zaki, Rafdzah Ahmad; Mariapun, Jeevitha; Ali, Rosli Mohd; Sari, Norashikin Md; Ismail, Muhammad Dzafir; Hian, Sim Kui

doi:10.11622/smedj.2015145

Cited by 23 publications

(28 citation statements)

References 26 publications

(23 reference statements)

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“…11 That the percentage of females affected with STEMI was much lower than males is supported by other studies where STEMI is more prevalent among males as compared to females. 9,12,13 However, females had a significantly higher mortality rate as compared to male patients in our study, which is compatible with other findings indicating that females have had higher mortality rates than males annually since 1984 with the cause of death mostly from myocardial infarction and sudden death. 14,15 Females are more resilient to developing CAD, but once they have CAD, they are more likely to experience the worse consequences.…”

Section: Discussionsupporting

confidence: 91%

“…1 In this setting, STEMI was defined as persistent ST segment elevation ≥1 mm in two contiguous electrocardiographic leads, or the presence of a new left bundle branch block in the setting of positive cardiac markers. 9 Data was collected from the time the patient with STEMI was admitted to the hospital until discharge. Each patient was assigned a unique national identifica-tion number to avoid duplication.…”

Section: Methodsmentioning

confidence: 99%

“…Primary PCI is the preferred treatment due to a better result. 9,42,43 Moreover, there were mortality advantages gained from PCI treatment for elderly patients even though the outcome of elderly patients after PCI is not as good as that of non-elderly patients. 9 In another study, the lack of PCI treatment in acute MI patients has contributed to the high in-hospital mortality among female patients with 12.3% as compared to 9.5% for males.…”

Section: Risk Factors In Stemi Patientsmentioning

confidence: 99%

“…9,42,43 Moreover, there were mortality advantages gained from PCI treatment for elderly patients even though the outcome of elderly patients after PCI is not as good as that of non-elderly patients. 9 In another study, the lack of PCI treatment in acute MI patients has contributed to the high in-hospital mortality among female patients with 12.3% as compared to 9.5% for males. 44 To overcome this problem, the Malaysian Ministry of Health, together with the Ministry of Education and National Heart Institute, initiated a better Kuala Lumpur STEMI network in 2015.…”

Section: Risk Factors In Stemi Patientsmentioning

confidence: 99%

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Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

et al. 2018

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BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients. OBJECTIVES: To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients. DESIGN: Retrospective analysis. SETTINGS: Hospitals across Malaysia. PATIENTS AND METHODS: We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender. MAIN OUTCOME MEASURES: Differential risk factors for each gender. RESULTS: For the 19 484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P<.001). The univariate analysis showed that the majority of male patients <65 years while females were ≥65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group. CONCLUSION: Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI. LIMITATION: Retrospective registry data with inter-hospital variation. C oronary artery disease (CAD) is the number one cause of mortality and morbidity in Malaysia and globally for both males and females. 1,2 Even worse, CAD has remained the principal cause of death for the ten years from 2005 to 2014. 3 In CAD, which is also known as ischemic heart disease, a waxy substance called plaque builds up inside the coronary arteries. 4 CAD, traditionally considered a male disease, is also a major threat to females nowadays. In general, females

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Risk Factors In Stemi Patientsmentioning

confidence: 99%

Section: Risk Factors In Stemi Patientsmentioning

confidence: 99%

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Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

et al. 2018

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“…A high percentage of patients with CAD typically have hypertension. In the Malaysian Acute Coronary Syndrome Registry, up to 72% of CAD patients have underlying hypertension [18]. Hypertension also commonly co-exist with another major risk factor of CAD namely diabetes mellitus.…”

Section: Hypertension and Coronary Artery Disease: From Pathophysiolomentioning

confidence: 99%

Treatment of Hypertension in Patients with Coronary Artery Disease

Rahman¹,

Yunus²

2016

J Clin Exp Cardiolog

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Hypertension is among the leading causes of mortality worldwide, both in the developed and developing world. Most deaths occur due to cardiovascular complications such as myocardial infarction (MI) and stroke. In the Asia Pacific Region, hypertension alone contributes to 66% of all cardiovascular deaths, more than it does worldwide. The most recent meta-analysis on the benefits of treating hypertension showed that tighter control of blood pressure (133/76 mmHg) leads to a significant 14% reduction in myocardial infraction. In patients with concurrent Coronary Artery Disease (CAD) the two issues which need to be addressed are: 1) to determine the target of blood pressure (BP), and; 2) to determine the drug of choice in hypertensive patients with concurrent CAD. Up to five years ago, most Clinical Practice Guidelines suggested that target BP to be achieved was <130/80 mmHg. This however was revised recently to <140/90 mmHg. The new cutoff was mainly due to lack of evidence from randomized controlled trials on the lower BP of <130/80 mmHg and the persistence concern about the J curve. This article reviewed recommendations made by the latest Hypertension Guidelines across major hypertension societies in North America, Europe and the Asia Pacific Region published over the last 3 years in the English language. These were than compared with major clinical outcome studies investigating phenotype of patients with hypertension and CAD. The treatment of choice for patients with CAD depends on clinical circumstances. In patients with underlying CAD, calcium channel blockers (verapamil) and beta blockers (atenolol) are indicated based on the INVEST trial. Besides, ACE I should also be the treatment of choice as indicated by the EUROPA trial especially in patients with minimal symptomatic angina. Beta blockers and dihydropyridine calcium channel blockers are indicated for symptomatic angina although there is no evidence of their impact on prognosis. For patients with previous myocardial infarction and normal left ventricular ejection fraction , ACE I and beta blockers are the drugs of choice to improve prognosis and clinical outcome although doubt has been raised on the benefits of beta blockers especially for mortality reduction. As for post-MI patients with reduced left ventricular ejection fraction, ACE I (or ARB), beta blockers and aldosterone antagonist are indicated.

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