Key result
Among 3149 adults hospitalized with acute coronary syndrome in India, 1-year all-cause mortality was 14.4% and composite major adverse cardiac events occurred in 17.6% of patients.
Why the study?
There are limited data on late outcomes of acute coronary syndrome in India.
Observational (n=3,149)
No
In a prospective cohort of ACS patients in South India, 1-year all-cause mortality was 14.4%, with older age, prior ACS, VT/VF, RBBB with Q wave, and LV systolic dysfunction associated with worse outcomes.
Background: There are limited data on the late outcome of the acute coronary syndrome (ACS) in India. We prospectively investigated the clinical characteristics, management, and 1-year outcomes of patients with ACS admitted to a tertiary care center of South India. Materials and Methods: In this prospective observational study, we enrolled 3149 adults hospitalized with a diagnosis of ACS between December 1, 2014 and March 31, 2017 at Government Medical College Kozhikode, Kerala. Patients were followed up at 30 days, 6 months, and 1 year. Primary outcome was all-cause mortality at 365 days. Secondary outcomes were 30-day mortality, sudden cardiac death (SCD), and major adverse cardiac events (MACEs) at 1 year after discharge. Results: A total of 3149 patients with ACS were admitted during the study period (48% with ST-elevation myocardial infarction [STEMI], 37% with non-ST-elevation MI [NSTEMI], and 15% unstable angina [UA]). The patients were of ages 58 ± 11.9 years. During hospitalization, the majority of the patients received guideline recommended drugs and percutaneous coronary intervention (PCI) was performed in 28%. Reperfusion therapy was performed in 88% of patients with STEMI (53% thrombolytic therapy and 45% including primary and rescue PCI). At 1 year, all-cause mortality and composite MACE after discharge were 14.4% and 17.6%, respectively. MACE included cardiovascular death (5.4%), re-infarction (15.7%), and non-fatal stroke (0.6%) after discharge. SCD at 1 year was 1.8%. The main factors associated with 1-year all-cause mortality and MACE were older age, prior history of ACS, ventricular tachycardia or ventricular fibrillation, right bundle branch block with Q wave, and left ventricular systolic dysfunction. Conclusion: One-year all-cause mortality after the admission of ACS was high, but post-discharge cardiovascular mortality was comparable to other developed countries. This highlights a better secondary prevention practices and risk stratification in our population.
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Kalliath et al. (2021) conducted an observational in Acute coronary syndrome (n=3,149). Among 3149 adults hospitalized with acute coronary syndrome in India, 1-year all-cause mortality was 14.4% and composite major adverse cardiac events occurred in 17.6% of patients.
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