Exploration of acute coronary syndrome among patients in the internal ward of Herat Regional Hospital, Afghanistan
DOI:
https://doi.org/10.56101/ajms.v1i1.115Keywords:
Acute Coronary Syndrome, Unstable Angina, STEMI, NSTEMI, Herat- AfghanistanAbstract
Background: Acute Coronary Syndromes (ACS) and sudden cardiac death, collectively responsible for 1.8 million deaths annually, are significant contributors to mortality associated with Ischemic Heart Disease (IHD). This study aims to comprehensively investigate patient profiles, including age, gender distribution, blood pressure levels upon admission, presence of secondary diseases, and medications used, and analyze their potential associations with different types of acute coronary syndromes.
Methods: This Medical Record Review conducted a thorough review of medical records of patients admitted to the internal medicine ward at Herat Regional Hospital with a diagnosis of acute coronary syndrome between 2016 and 2021. A total of 500 patients were randomly selected from admission records, and 359 cases were confirmed to have acute coronary syndrome.
Results: Among the studied patients, 202 (56.3%) were male. More than half of the patients, 194 (54.0%), presented with high blood pressure at admission, and 266 (74.1%) had a history of secondary diseases. The identified types of ACS among patients were Unstable Angina (46.6%), ST-Elevation Myocardial Infarction (STEMI) (39.8%), and Non-ST-Elevation Myocardial Infarction (NSTEMI) (19.6%). Significant relationships were observed between the type of acute coronary syndrome, gender, blood pressure at admission, and the presence of secondary diseases.
Conclusion: At Herat Regional Hospital, acute coronary syndromes are classified as Unstable Angina, STEMI, and NSTEMI. Approximately one-third of initially diagnosed acute coronary syndrome cases had a different final diagnosis. High blood pressure is prevalent among patients with acute coronary syndrome at Herat Regional Hospital. Accurate classification and determination of the type of acute coronary syndrome at the time of initial diagnosis should consider gender, blood pressure at admission, and the presence of secondary diseases.
References
Zipes DP. Braunwald's heart disease: a textbook of cardiovascular medicine. BMH Medical Journal-ISSN 2348–392X. 2018 Mar 2;5(2):63-.
Cardiovascular diseases [Internet]. World Health Organization; [cited 2023 Jul 3]. Available from: https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
Caputo ML, van Stipdonk A, Illner A, D'Ambrosio G, Regoli F, Conte G, Moccetti T, Klersy C, Prinzen FW, Vernooy K, Auricchio A. The definition of left bundle branch block influences the response to cardiac resynchronization therapy. International journal of cardiology. 2018 Oct 15;269:165-9.
Roger VL. Epidemiology of myocardial infarction. Medical Clinics of North America. 2007 Jul 1;91(4):537-52.
DeVon HA, Mirzaei S, Zègre‐Hemsey J. Typical and atypical symptoms of acute coronary syndrome: time to retire the terms?. Journal of the American Heart Association. 2020 Apr 9;9(7):e015539.
Gu SZ, Beska B, Chan D, Neely D, Batty JA, Adams‐Hall J, Mossop H, Qiu W, Kunadian V. Cognitive decline in older patients with non‐ST elevation acute coronary syndrome. Journal of the American Heart Association. 2019 Feb 19;8(4):e011218.
Eliopoulos C. Gerontological nursing. Lippincott Williams & Wilkins; 2013 Feb 1.
Madjidova GT, Sunnatova GI, Usarov SA. ABOUT THE SYSTEM OF TREATMENT OF PATIENTS WITH ACUTE CORONARY SYNDROME. Евразийский журнал медицинских и естественных наук. 2022 May 10;2(5):197-204.
Nobahar M, Vafaei A. Comparison of classic symptoms in acute coronary syndromes among young and old patients. Journal of Inflammatory Diseases. 2005 May 10;9(1):18-22.
Birnbaum Y, Wilson JM, Fiol M, de Luna AB, Eskola M, Nikus K. ECG diagnosis and classification of acute coronary syndromes. Annals of Noninvasive Electrocardiology. 2014 Jan;19(1):4-14.
Adar A, Onalan O, Cakan F. Relationship between ST-segment shifts in lead aVR and coronary complexity in patients with acute coronary syndrome. Acta Cardiologica Sinica. 2019 Jan;35(1):11.
Birnbaum Y, Rankinen J, Jneid H, Atar D, Nikus K. The role of ECG in the diagnosis and risk stratification of acute coronary syndromes: an old but indispensable tool. Current cardiology reports. 2022 Feb;24(2):109-18.
Birnbaum Y, Wilson JM, Fiol M, de Luna AB, Eskola M, Nikus K. ECG diagnosis and classification of acute coronary syndromes. Annals of Noninvasive Electrocardiology. 2014 Jan;19(1):4-14.
Smith SW, Whitwam W. Acute coronary syndromes. Emergency Medicine Clinics. 2006 Feb 1;24(1):53-89.
Becker RC, Alpert JS. Electrocardiographic ST segment depression in coronary heart disease. American heart journal. 1988 Apr 1;115(4):862-8.
Braat SH, Brugada P, den Dulk K, van Ommen V, Wellens HJ. Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. The American journal of cardiology. 1984 Jun 1;53(11):1538-41.
Atar S, Barbagelata A, Birnbaum Y. Electrocardiographic diagnosis of ST-elevation myocardial infarction. Cardiology clinics. 2006 Aug 1;24(3):343-65.
Kotecha T, Rakhit RD. Acute coronary syndromes. Clinical Medicine. 2016 Dec;16(Suppl 6):s43.
Yusuf S, Pearson M, Sterry H, Parish S, Ramsdale D, Rossi P, Sleight P. The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction. European Heart Journal. 1984 Sep 1;5(9):690-6.
Arslan F, Damman P, Zwart BD, Appelman Y, Voskuil M, de Vos A, van Royen N, Jukema JW, Waalewijn R, Hermanides RS, Woudstra P. 2020 ESC Guidelines on acute coronary syndrome without ST-segment elevation: Recommendations and critical appraisal from the Dutch ACS and Interventional Cardiology working groups. Netherlands Heart Journal. 2021 Nov;29(11):557-65.
Timmis A, Kazakiewicz D, Townsend N, Huculeci R, Aboyans V, Vardas P. Global epidemiology of acute coronary syndromes. Nature Reviews Cardiology. 2023 May 25:1-1.
Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Annals of translational medicine. 2016 Jul;4(13).
Boussouf K, Zaidi Z, Kaddour F, Djelaoudji A, Benkobbi S, Bayadi N, Taiar S. Clinical Epidemiology of Acute Myocardial Infarction in Setif, Algeria: Finding from the Setif-AMI Registry. Health Science Journal. 2019;13(1):1-6.
Ogata S, Marume K, Nakai M, Kaichi R, Ishii M, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K. Incidence rate of acute coronary syndrome including acute myocardial infarction, unstable angina, and sudden cardiac death in Nobeoka City for the super-aged society of Japan. Circulation Journal. 2021 Sep 24;85(10):1722-30.
Mohammed OS, Mirghani HO, Alyoussuf AA, Albalawi SO, Mustafa ME. Pattern and outcomes of acute myocardial infarction in Tabuk, Saudi Arabia. Basic Research Journal of Medicine and Clinical Sciences. 2015;4(7):193-8.
Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, Lemesle G, Motreff P, Popovic B, Khalife K, Labèque JN. Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017 Nov 14;136(20):1908-19.
Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. The lancet. 2000 Feb 26;355(9205):675-87.
Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa K, Keil U. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. The Lancet. 2000 Feb 26;355(9205):688-700.
Rosengren A, Wallentin L, Simoons M, Gitt AK, Behar S, Battler A, Hasdai D. Cardiovascular risk factors and clinical presentation in acute coronary syndromes. Heart. 2005 Sep 1;91(9):1141-7.
Jafari H, Shafipour V, Mokhtarpour R, Rhanama N, Esmaeili R, Nasiri E. Study of some risk factors and accelerating factors of heart attack and the delay reasons in referring to theMazandaran Cardiac Center in 2009. Journal of Mazandaran University of Medical Sciences. 2009 Dec 10;19(73):68-74.
Fauci AS, BRAUNWALD C, Isselbacher K, Wilson J, Martin J, Kasper D, Hauser S, Longo D. Harrison's: Principles of Internal Medicine. v. 2: il. New Youk: McGraw-Hill. 1998.
Hellermann JP, Reeder GS, Jacobsen SJ, Weston SA, Killian JM, Roger VL. Longitudinal trends in the severity of acute myocardial infarction: a population study in Olmsted County, Minnesota. American journal of epidemiology. 2002 Aug 1;156(3):246-53.
Rosengren A, Thelle DS, Köster M, Rosen M. Changing sex ratio in acute coronary heart disease: data from Swedish national registers 1984–99. Journal of internal medicine. 2003 Mar;253(3):301-10.
McGovern PG, Jacobs Jr DR, Shahar E, Arnett DK, Folsom AR, Blackburn H, Luepker RV. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota heart survey. Circulation. 2001 Jul 3;104(1):19-24.
Rosengren A, Wallentin L, Gitt AK, Behar S, Battler A, Hasdai D. Sex, age, and clinical presentation of acute coronary syndromes. European heart journal. 2004 Apr 1;25(8):663-70.
Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, Aylward P, Topol EJ, Califf RM. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. New England Journal of Medicine. 1999 Jul 22;341(4):226-32.
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The lancet. 2004 Sep 11;364(9438):937-52.
Sharma R, Bhairappa S, Prasad SR, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south Indian population. Heart India. 2014 Jul 1;2(3):65.
Ralapanawa U, Kumarasiri PV, Jayawickreme KP, Kumarihamy P, Wijeratne Y, Ekanayake M, Dissanayake C. Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC cardiovascular disorders. 2019 Dec;19(1):1-9.
Andrikopoulos GE, Tzeis S, Mantas I, Olympios C, Kitsiou A, Kartalis A, Kranidis A, Tsaknakis T, Richter D, Pras A, Pipilis A. Epidemiological characteristics and in-hospital management of acute coronary syndrome patients in Greece: results from the TARGET study. Hellenic J Cardiol. 2012 Jan 1;53(1):33-40.
Ali WM, Zubaid M, El-Menyar A, Mahmeed WA, Al-Lawati J, Singh R, Ridha M, Al-Hamdan R, Alhabib K, Suwaidi JA. The prevalence and outcome of hypertension in patients with acute coronary syndrome in six Middle-Eastern countries. Blood pressure. 2011 Feb 1;20(1):20-6.
Access Investigators. Management of acute coronary syndromes in developing countries: acute coronary events—a multinational survey of current management strategies. American heart journal. 2011 Nov 1;162(5):852-9.
Medagama A, Bandara R, De Silva C, Galgomuwa MP. Management of acute coronary syndromes in a developing country; time for a paradigm shift? an observational study. BMC cardiovascular disorders. 2015 Dec;15:1-8. https://doi.org/10.1186/s12872-015-0125-y.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ghullam Dawood Hashemi, Faramarz Hasanzadeh, Saeed Walid Zaheen, Elham Hasanzadeh, Basir Ahmad Mohammadi, Nosaibah Razaqi
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
