Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting

Abstract

ObjectiveTo measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting.MethodsFrom February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality.ResultsFrom hospital admission, patients were followed over a median of 18 (IQR 6–36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88).ConclusionsPatients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study

“…In the study setting, the delayed initiation of invasive diagnostic and therapeutic options, coronary angiography started on February 2016 and PCI on April 2016, might explain the mortality rate. Similarly, another study from south east Asian setting reported that unavailability of revascularization therapy was associated with high mortality rate (HR; 2.38, p = 0.005) [46]. However, our finding was higher than studies from India 3.9% [22], Czech republic 4.2% [47], Brazil 9.4% [48], Pakistan 12.2% [49], Kenya 9.4% [30] and Sub-Saharan African countries 10% [10].…”

Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes

“…distance ≥20 kms from hospital). In our previous study, all these variables are shown to be the independent predictors for mid-term all-cause mortality in patients with coronary artery disease in Indonesia 11 . We considered a 95% confidence interval not including one, with p-value < 0.05 as statistically significant.…”

“…We excluded all patients who immediately died in the emergency department or intensive cardiovascular care unit before giving informed consent, and all patients in whom coronary angiography had been confirmed as normal (defined as 0% lumen stenosis in all coronary vessels) 10 . Detailed description and flowchart of the study population has been previously reported 11 .…”

Assessment of the Diagnostic Accuracy of C-Reactive Protein and Pentraxin3 in Acute Coronary Syndrome Compared with Cardiac Troponin-1

“…In A.Qanitha [16] which assess the Predictors of medium-term mortality in patients hospitalised with coronary artery disease, there was statistical significant difference regarding age and sex.…”