The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala.

BACKGROUND The clinical profile and the mortality rate among patients with acute coronary syndromes (ACS) are not well studied in Kerala. AIMS To determine the clinical characteristics, mortality rate and possible risk factors for high mortality among patients with ACS. SETTINGS AND DESIGN Retrospective study conducted at Kottayam Medical College, a large teaching hospital. PATIENTS AND METHODS Successive cases presenting with ACS to the coronary-care unit between May 2005 and December 2006 were included. Cases were grouped into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction/unstable angina (NSTEMI/UA) for the purpose of analysis. Statistical analysis : Univariate analysis using chi square test and unpaired t test. RESULTS Among 1865 patients treated for ACS, 1359 (72.9%) were males. One hundred fifty (8.04%) died during treatment. One thousand forty-four (56%) had STEMI and 376 of them (36%) occurred between 12 pm and 6 pm. One hundred twenty-five patients (11.97%) with STEMI died. Significantly higher mortality rates were observed among females (22.8% vs. 9%; p<0.001), cases with inferior wall infarctions (17% vs. 7%; p=0.001) and cases not receiving thrombolysis (15% vs. 10%, p=0.005). Diabetes mellitus (OR=1.96), age >75 years (OR=2.42) and higher Killip class at admission were associated with high mortality. Eight hundred twenty five cases (44%) had NSTEMI/UA. Twenty five of them (3.05%) died. Higher proportion of cases with NSTEMI/UA in comparison to STEMI had hypertension (43% vs. 29.02%; p<0.001) and diabetes mellitus (41.05% vs. 23.95%; p<0.001), and had been females (34.96% vs. 21%; p=0.002). Mortality rate was higher among females (4.5% vs. 2.2%; p=0.016) CONCLUSIONS The mortality rates in ACS and STEMI remain high in this hospital. Subjects with diabetes mellitus, females and elderly individuals had greater mortality rates and are high risk groups.