A Clinical profile of patients enrolled in the Pakistan ACS registry Sadia Arshad, Javed M Tai, Khawar A Kazmi Cardiology section, Medicine department Aga Khan University Hospital Karachi 4/14/2018 Department of Medicine

Timely and correct diagnosis has clinical and prognostic implications Background: Acute coronary syndrome is a clinical syndrome secondary to myocardial ischemia , categorized according to the clinical presentation of patients as unstable angina and myocardial infarction. Timely and correct diagnosis has clinical and prognostic implications Objectives: To assess the clinical characteristics , treatment given, revascularization strategy and outcomes of patients admitted to three tertiary care centers with the diagnosis of acute coronary syndrome   4/14/2018 Department of Medicine

Methodology This was a descriptive study conducted from March 2008 to December 2010 in the cardiology departments of three centers ; the Aga Khan University Hospital, Tabba Heart Institute, and Civil Hospital Karachi. Patients were prospectively enrolled from the emergency departments of all three centers and screened for eligibility. The patients were followed till death or discharge from the hospital for outcome data. 4/14/2018 Department of Medicine

Students T test was used to compare means for quantitative data. Pearsons Chi square was used to compare differences in categorical data between groups. Anova was used to compare differences in means between the three groups. P values <0.05 were considered significant.   4/14/2018 Department of Medicine

Results 1430 patients enrolled(AKU=397 THI=692 CHK=341) Mean age was 63.7±18 years. Strong male preponderance (75%) Diabetes(35%) hypertension(47%) current or ex smokers (42% ) 4/14/2018 Department of Medicine

Majority of patients had a diagnosis of myocardial infarction (73%) Shortest time to presentation was at CHK (mean time to arrival was 2.6 ±3.83 hrs vs THI (6.84± 5.8) AKU ( 6.65±8.2 hours) Majority of patients had a diagnosis of myocardial infarction (73%) We found a higher than expected percentage of ST elevation in the patients with MI (66%), mostly anterior. 4/14/2018 Department of Medicine

33% received thrombolytics. Primary PCI was performed in 42% and rescue PCI in 3.3% Patients were mostly treated according to the guidelines Mean LVEF was 48.2±17%.   4/14/2018 Department of Medicine

Revascularization strategy N (%) P value AKU THI CHK   AKU THI CHK Thrombolysis 8/231 (3.4) 131 (32.3) 96/149(64) <0.05 Eligible for but not considered for thrombolysis Late presentation Contraindications 14(6.0) 51 (22) 61 (15) 10(2.5) 35 (23.4) 6 (4.0) In-hospital coronary angiogram 277 (69.8) 561 (81.1) 101(29.5) PCI 220 (55.4) 309 (44.6) 48(14) Primary PCI Rescue PCI 150 (37.8) 4.0 (1) 127(31.3) 17/ (4.1) 22 (14.7) 2(1.34) CABG 43 (10.8) 46 (6.6) 2(0.6)  In Hospital complications N (%)  P   AKU THI CHK Death 11 (2.8) 18(2.6) 5(1.5) NS Re-infarction 1 (0.3) 1(0.1) 1(0.3) Ventricular tachyarrythmias/SCD 10 (2.5) 3(0.4) 10(3) CVA 2 (0.5) 11(1.6) 3(0.9) Cardiogenic shock 14 (3.5) 2(0.3) Pulmonary embolism 1(0.2) 3 (0.4) 2(0.5) Major bleed requiring transfusion 4(1.0) 4/14/2018 , Department of Medicine

Conclusion Patients with ACS in this study were predominately male , had a higher proportion of MI, (especially STEMI) and underwent catheter based intervention more than expected in this series. Mortality was lower than expected. 4/14/2018 Department of Medicine

Strengths/limitations This study was done in public and private sector hospitals to ensure that patients from all areas and SES in Karachi would be able to be enrolled. Selection bias Data collection issues Needs to be done all over the country in all communities. 4/14/2018 Department of Medicine

4/14/2018 Research Day 2013, Department of Medicine