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      Treatment Outcomes of the Acute Coronary Syndrome Among Patients Attending St. Paul Hospital

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          Abstract

          Background

          Acute coronary syndrome (ACS) patients need intense therapy and diagnostic evaluation for improved treatment. In Ethiopia, where patient deaths and hospital stays are rising, the ACS treatment is thought to be not very effective.

          Methods

          A retrospective cross-sectional study was conducted at St. Paul Hospital. The data were collected from patients medical records using a structured data abstraction checklist from 2018 to 2020. The data was entered, analyzed, and interpreted using SPSS version 24 software.

          Results

          Of 157 ACS patients, 69 (43.9%) had a STEMI diagnosis. Age was 63.69 years on average (SD: 8.23). The typical amount of time between the onsets of ACS symptoms to hospital presentation was 79.3 hours (3.3 days). For 104 (66.2%) patients, hypertension was the main risk factor for the development of ACS. Killip class III and IV patients made up about 3.8% of the ACS patients at St. Paul hospital. An EF of less than 40% was present in 36.3% of patients. Loading doses of aspirin (90.4%), anticoagulants (14%), beta-blockers (82.8%), statins (86%), clopidogrel (7.6%), and nitrates (2.5%) are among the medications taken inside hospitals. Of 157 ACS patients, 6 (3.8%) patients with medical records examined died while receiving treatment in the hospital, while 151 (96.2%) patients were discharged alive.

          Conclusion

          STEMI was the most common diagnosis for ACS patients at St. Paul Hospital. The two main hospital events for these patients were CHF and cardiogenic shock.

          Most cited references23

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          Predictors of hospital mortality in the global registry of acute coronary events.

          Management of acute coronary syndromes (ACS) should be guided by an estimate of patient risk. To develop a simple model to assess the risk for in-hospital mortality for the entire spectrum of ACS treated in general clinical practice. A multivariable logistic regression model was developed using 11 389 patients (including 509 in-hospital deaths) with ACS with and without ST-segment elevation enrolled in the Global Registry of Acute Coronary Events (GRACE) from April 1, 1999, through March 31, 2001. Validation data sets included a subsequent cohort of 3972 patients enrolled in GRACE and 12 142 in the Global Use of Strategies to Open Occluded Coronary Arteries IIb (GUSTO-IIb) trial. The following 8 independent risk factors accounted for 89.9% of the prognostic information: age (odds ratio [OR], 1.7 per 10 years), Killip class (OR, 2.0 per class), systolic blood pressure (OR, 1.4 per 20-mm Hg decrease), ST-segment deviation (OR, 2.4), cardiac arrest during presentation (OR, 4.3), serum creatinine level (OR, 1.2 per 1-mg/dL [88.4- micro mol/L] increase), positive initial cardiac enzyme findings (OR, 1.6), and heart rate (OR, 1.3 per 30-beat/min increase). The discrimination ability of the simplified model was excellent with c statistics of 0.83 in the derived database, 0.84 in the confirmation GRACE data set, and 0.79 in the GUSTO-IIb database. Across the entire spectrum of ACS and in general clinical practice, this model provides excellent ability to assess the risk for death and can be used as a simple nomogram to estimate risk in individual patients.
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            Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry.

            There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal ( 6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE. These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.
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              The evolving epidemiology of acute coronary syndromes.

              The clinical entities that comprise acute coronary syndromes (ACS)-ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina-have been recognized as widespread causes of death and disability for more than a century. Seminal research in the past 50 years has led to important scientific and medical advances in our understanding of ACS. Rapid modernization of the developing world has led to a pandemic of coronary artery disease and its manifestation as ACS, with profound implications for personal, societal, and global health. Epidemiological studies have provided insight into the changing demographics of ACS, and highlighted the importance of modifiable risk factors and adherence to guideline-recommended therapy.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                tcrm
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                27 January 2023
                2023
                : 19
                : 105-114
                Affiliations
                [1 ]Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar , Gondar, Ethiopia
                [2 ]Department of Internal Medicine St. Paul Hospital Millennium Medical College , Addis Ababa, Ethiopia
                [3 ]Department of Social & Administrative Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar , Gondar, Ethiopia
                [4 ]Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar , Gondar, Ethiopia
                Author notes
                Correspondence: Yeniewa Kerie Anagaw, Email yeniewa21@gmail.com
                Author information
                http://orcid.org/0000-0002-1096-4773
                Article
                382422
                10.2147/TCRM.S382422
                9888011
                a5625bf4-1b21-4e75-98ac-41e20bb6c9eb
                © 2023 Anagaw et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 18 July 2022
                : 24 January 2023
                Page count
                Figures: 2, Tables: 6, References: 30, Pages: 10
                Funding
                Funded by: funding;
                There is no funding to report.
                Categories
                Original Research

                Medicine
                acute coronary syndrome,treatment outcome,killip class,ethiopia
                Medicine
                acute coronary syndrome, treatment outcome, killip class, ethiopia

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