Outcomes and Predictors of In-Hospital Mortality in Patients Presenting with Acute Coronary Syndromes

Cader, Fathima Aaysha

Background:
Outcome of acute coronary syndromes (ACS) varies internationally, given regional differences in patient demographics and management practices. There is no organized ACS registry in the country thus far. This study aimed to identify predictors of mortality ACS patients admitted to a tertiary care cardiac centre in the capital city.

Methods:
This retrospective study included ACS patients presenting to our hospital from January to December 2013. Data were collected from hospital discharge records and catheterization laboratory database, and analysed. P < 0.05 was considered statistically significant.

Results:
1914 ACS patients were studied. 71.4% were male. 39.8% presented with ST-elevation myocardial infarction (STEMI), 39.7% with non-ST-elevation myocardial infarction (NSTEMI) and 20.5% with unstable angina (UA). There were 146 in-hospital deaths (7.6%). Mortality was highest among STEMI patients (10.5%), followed by NSTEMI (8.1%) and UA (1.03%). Mean age of expired patients was 64.82 ± 12.14 years. Mortality was significantly associated with increased age, with patients ≥ 50 years having an odds ratio [OR] of 2.6 (p <0.001). Chronic kidney disease (OR 2.7, p<0.001), STEMI presentation (OR 1.8, p<0.001), admission heart rate < 60 beats/minute (OR 2.9, p <0.001), cardiogenic shock (OR 22.6, p <0.001), acute left ventricular failure (LVF) (OR 4.3, p< 0.001) and uncontrolled diabetes, i.e. HbA1c levels ≥7.5% (OR 51.4, p <0.001) had significantly higher risk of mortality, as did ACS patients who did not undergo angiography (OR 16.4; p <0.001) or PCI (OR 70.4, p<0.001). Multivariate analysis revealed that cardiogenic shock (OR 6.1), LVF (OR 2.7) and uncontrolled diabetes (OR 86.1) were independent predictors of mortality among ACS patients.

Conclusions:
Cardiogenic shock, LVF, uncontrolled diabetes, age > 50 years and CKD were associated with in-hospital death among ACS patients in our study. Prospective registries with greater involvement of other cardiac centres nation-wide are warranted.