Predictors of 6-month Mortality in Patients with Non-ST Elevation Acute Coronary Syndrome: A Study in Pakistani Population

Abstract

Objectives For Southern Asian countries like Pakistan, there is inadequate evidence of risk factors associated with mortality in patients suffering from acute coronary syndrome (ACS), especially non-ST elevation ACS (NSTE-ACS) cases. Therefore, aim of this study was to evaluate predictors of 6-months mortality of patients presenting with NSTE-ACS. Methods For this prospective observational study we recruited adult patients diagnosed with NSTE-ACS at a tertiary cardiac center. All he patients were followed-up after six months and survival status was recorded. Logistic regression analysis was performed for six-month mortality and odds ratio (OR) and 95% confidence interval (CI) were reported. Results Six-month follow-up was successful for 280 patients. On univariate analysis age >65 years, increased heart rate, cardiac arrest at presentation, Killip class II–IV at presentation, and diabetes were found to be associated with increased risk of 6-months mortality with OR [95% CI] of 4.27 [1.9–9.58], 1.25 [1.1–1.41], 139.44 [16.9–1150.78], 68.45 [7.88–594.41], and 2.35 [1.06–5.22] respectively. On multivariable analysis Killip class II–IV at presentation, thrombolysis in myocardial infarction (TIMI) score of >4, and global registry of acute coronary events (GRACE) score ≥150 were found to be independent predictors of mortality after six months of NSTE-ACS with adjusted OR of 32.93 [2.65–408.8], 3.42 [1.35–8.66], and 8.43 [3.33–21.38] respectively. Conclusions For patients with NSTE-ACS, our study showed seven clinical parameters to be associated with an increased risk of 6-month mortality. These included increasing age, increased heart rate, cardiac arrest at presentation, Killip class II–IV, diabetes, TIMI score of >4 and GRACE score of >150. Thereby aiding clinicians to apply strategic and precise interventions in monitoring these patients accordingly.

Association of Quantitative ST- Segment Depression with Early Mortality among Naive Patients of Non- ST- Segment Elevation Acute Coronary Syndrome

“…9 The degree of ST segment deviation on admission ECG is not only a short-and long-term predictor of death but also of additional problems. 13,14 Despite considerable advancements in cardiac therapy and its management, 15,16 In the support of this study Awan MS et al 17 also concluded that the proportion of ST-segment depression on admission from standard 12 leads In individuals having NSTEMI, the ECG is a reliable indicator of in-hospital death.…”

Echocardiographic Wall Motion Score in the Naive Patients of Non-ST Segment Elevation Acute Coronary Syndrome Regarding their Early Mortality

“…The survival rate decreases with an increasing wall motion score index and an ischemia-free stress period. 22 Dobutamine and dipyridamole tests have been found to have comparable predictive values when compared to other pharmacological stress modalities. 22 Hard cardiac episodes can be predicted by overexpression ischemia at stress echocardiography, as well as the risk is correlated with the magnitude of the inactivating abnormality as measured by the maximum wall motion score index.…”

“…16,17 In this study, the overall short-term mortality rate was 20.3% Which was significantly assisted by the high grade of wall motion score (p-0.001). In the study of Kumar D et al 18 reported that at six months, the death rate for individuals having NSTE-ACS was reported to be 10%; however, information on these individuals' post-discharge outcomes is scant, particularly in the region of South Asia. According to the study by Kim HK et al 19 based on the Korea Acute Myocardial Infarction Registry, the death rate following NSTEMI was 14.3% after one year.…”

“…22 Hard cardiac episodes can be predicted by overexpression ischemia at stress echocardiography, as well as the risk is correlated with the magnitude of the inactivating abnormality as measured by the maximum wall motion score index. 22,23…”

Effects of atrioventricular blocks in acute coronary syndrome: Long-term follow-up.

“…Such arrhythmias are usually transient and typically resolve within 24 h. However, it is vital to recognize and initiate necessary treatment early as they can progress to irreversible and lethal disturbances. [ 2 ]…”