NCVD Acute Coronary Syndrome (ACS) Registry An Update Dato’ Dr Azhari Rosman Chairman of NCVD ACS Registry Sentral Accord Room, Hilton Kuala Lumpur 19th April 2009 National Cardiovascular Disease Database (NCVD)

ACS Registry Participating Sites *HSB *HTF *HRPZ II *PH HSJ *QEH HSNZ *HI *HTAA *IJN *UMMC *HKL *HTAR *SGH *HTJ *HSAJB *HM MMC (2009) National Cardiovascular Disease Database (NCVD) * Active sites

Current Activities 1. Report: NCVD-ACS Registry Annual report year 2006 Downloadable online at http://www.acrm.org.my/ncvd/publications.htm National Cardiovascular Disease Database (NCVD)

Currently in the midst of data-cleaning stage Current Activities 2. NCVD-ACS Registry Annual Report year 2007 Currently in the midst of data-cleaning stage National Cardiovascular Disease Database (NCVD)

(based on unclean data) Current Updates as of 9th April 2009 (based on unclean data) National Cardiovascular Disease Database (NCVD)

Acute Coronary Syndrome (ACS) Registry National Cardiovascular Disease Database (NCVD)

ACS cases registered online by Source Data Providers (SDP) Results as of 9th April 2009, n= 10,864 Total SDP = 15 sites National Cardiovascular Disease Database (NCVD)

Patient’s Demographics Baseline (n= 10,730) Age Min, Max mean + sd 18.33, 99.52 yrs 59.05 + 11.99 yrs Male 75.31 % Baseline (n= 10,864) Ethnic : Malay 47.47 % Chinese 22.96 % Indians 23.25 % Other Malaysian 3.88 % Foreigner 1.33 % * Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli, Melanau, Murut, Bajau, Bidayuh ** For 121 cases, there are no information on ethnicity National Cardiovascular Disease Database (NCVD)

Smoking Status Status of Aspirin use Never 36.25 % Stopped (quit > 30 days) 21.45 % Current (within last 30 days) 32.03 % Not Available 10.27 % Status of Aspirin use Used <7 days 10.47 % Used >7 days 22.06 % None 51.96 % Unknown 15.51 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

CV Risk Factors Results as of 9th April 2009, n= 10,864 Dyslipidaemia 32.42 % Hypertension 57.69 % Diabetes 40.56 % Family History of premature CVD 11.16 % MI history 16.68 % Documented CAD 16.21 % New onset angina (< 2 weeks) 48.08% Chronic angina (onset > 2 weeks ago) 11.29% Chronic Lung Disease 3.26 % Renal disease 6.40 % Peripheral vascular disease 0.75 % Cerebrovascular disease 3.42 % Heart Failure 6.46 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Risk Factors: Malaysian NCVD-PCI Registry(IJN) 51% 82% Why IHD has many ED- due to incd comobiditiues 72%

Number of distinct angina episode within 24hrs No episode 14.42 % 1 36.38 % 2 7.52 % 3 2.73 % 4 0.71 % 5 0.38 % 6 0.14 % 7 0.06 % 8 0.02 % 9 10 0.07 % 11 12 0.01 % 14 0.03 % 20 NA 37.48 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Not stated/inadequately described Clinical Examination Heart Rate 83.5 beats/min Systolic BP 139.74 mmHg Diastolic BP 81.12 mmHg Killip classification I 46.27 % II 16.37 % III 3.94 % IV 3.31 % Not stated/inadequately described 12.73 % Not available 17.38 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

ECG abnormalities type Baseline (n= 10,864) ST-segment elevation ≥ 1mm (0.1mV) in ≥ 2 contiguous limb leads 17.31 % ST-segment elevation ≥ 2mm (0.2mV) in ≥ 2 contiguous frontal leads or chest leads 31.16 % ST-segment depression ≥ 0.5mm (0.05mV) in ≥ 2 contiguous leads 24.57 % T-wave inversion ≥ 1mm (0.1mV) 20.54 % Bundle branch block (BBB) 4.95 % Non-specific 5.23 % None 6.01 % Not stated / inadequately described 1.86 % Results as of 9th April 2009 National Cardiovascular Disease Database (NCVD)

ECG abnormalities location Baseline (n= 10,864) Inferior leads : II, III, aVF 31.42 % Anterior leads : V1 to V4 41.96 % Lateral leads : I, aVL, V5 to V6 30.23 % True posterior : V1 V2 4.58 % Right ventricle : ST elevation in lead V4R 3.77 % None 9.86 % Not stated / inadequately described 3.89 % Results as of 9th April 2009 National Cardiovascular Disease Database (NCVD)

Percentage of Ischaemic status by ACS stratum (n=10,864) Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Percentage according to TIMI Risk Score for STEMI (n= 4,705) Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Percentage according to TIMI Risk Score for NSTEMI/UA (n=5,427) Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Fibrinolytic Therapy Status Baseline (n= 4,705) Given at this centre 60.81 % Given at another centre prior to transfer 12.41 % Not given - proceeded directly to primary angioplasty 7.25 % Not given - Missed Thrombolysis 12.48 % Not given - patient refusal 0.17 % Not given - Contraindicated 4.21 % Not Applicable 2.67 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Fibrinolytic Drug Used (n=2,861) Streptokinase 91.68 % Others 2.31 % Missing 6.01 % Door to needle time (mins) 94.36 + 145.24 Baseline (n= 10,864) Cardiac Cathetherization Yes 19.00 % No 60.73 % No - transferred to another centre 2.31 % Missing 17.95 % Results as of 9th April 2009 National Cardiovascular Disease Database (NCVD)

Door to balloon time (mins) 233.77 + 292.63 PCI on this admission Yes (n=1,588) 14.62 % Yes – for STEMI 42.1 % No 55.56 % Not Applicable 12.08 % Missing 17.75 % Door to balloon time (mins) 233.77 + 292.63 Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Pharmacological Therapy Drug used/given during admission (%) Drug Pre-admission During After discharge ASA 52.26 85.98 69.78 ADP Antagonist 20.50 60.53 47.08 GP Receptor inhibitor 0.52 2.90 Unfrac Heparin 1.29 11.36 LMWH 9.75 50.64 Beta Blocker 24.51 61.73 52.40 ACE Inhibitor 18.87 53.57 45.08 Angiotensin II receptor blocker 4.60 7.35 6.32 Statin 30.03 83.97 69.31 Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Pharmacological Therapy Drug used/given during admission (%) Pre-admission During After discharge Other Lipid Lowering Agent 2.34 5.40 4.41 Diuretics 12.56 28.68 17.04 Calcium Antagonist 9.89 14.28 11.17 Oral Hypoglycaemic Agent 19.40 24.98 25.03 Insulin 6.93 23.38 8.17 Anti-arrhythmic Agent 2.22 6.66 3.55 Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

In-hospital Clinical Outcome Discharged 85.65 Transferred 1.98 Died 6.91 NA 5.55 Cause of Death (%) CVD 74.57 Non-CVD 4.39 Other 2.26 Missing 18.77 Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

In-hospital Clinical Outcome Final Diagnosis at Discharge (%) Q Wave MI 35.76 Non-Q Wave MI 19.89 Unstable Angina 24.96 Stable Angina 1.20 Non-cardiac 1.45 Missing 16.74 Bleeding Complication (TIMI Criteria) (%) Major 0.49 Minor 1.58 Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Follow up at 30days & 1year National Cardiovascular Disease Database (NCVD)

Overall Follow Up Management Type of FU 30days FU 1year FU Total N % Expected visits 9650 7604 FU Done 6493 67.28 3352 44.08 Missed FU 3157 32.72 4252 55.92 Results as of 9th April 2009 National Cardiovascular Disease Database (NCVD)

Overall Follow Up done at 30days & 1year National Cardiovascular Disease Database (NCVD)

Follow Up done at 30days & 1year by SDP Percentage of FU done (%) Total 30days FU = 6,493 (as of 9th April 2009) Total 1year FU = 3,352 (as of 9th April 2009) National Cardiovascular Disease Database (NCVD)

Cardiovascular readmission 30days (n= 6,550) 1year (n= 3,374) ACS STEMI NSTEMI UA Missing 3.89 % 14.51 % 14.90 % 53.73 % 16.86 % Heart Failure 0.49 % Revascularization 5.15 % PCI 87.54 % CABG 9.79 % Stroke 0.11 % 2.07 % 12.86 % 7.14 % 61.43 % 11.43 % 0.53% 3.11% 78.09 % 15.24 % 0.06 % Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Outcome at 30 days & 12 months Alive Death Lost to FU Transferred Missing 85.39 % 3.45 % 8.98 % 0.58 % 1.6 % 30days (n= 6,550) 84.53 % 2.31 % 10.58 % 0.18 % 2.4 % 1year (n= 3,374) Cause of Death CVD Non CVD Others Missing 55.31 % 10.62 % 13.27 % 20.80 % 30days (n= 226) 47.44 % 8.97 % 21.79 % 21.80 % 1year (n= 78) Results as of 9th April 2009, n= 10,864 National Cardiovascular Disease Database (NCVD)

Thank you National Cardiovascular Disease Database (NCVD)