scholarly journals Acute Coronary Syndrome in Malaysian Octogenarian: Trends in Demographics and In-Hospital Managements

2021 ◽  
Author(s):  
Siti Zaleha Suki ◽  
Ahmad Syadi Mahmood Zuhdi ◽  
Abqariyah Yahya ◽  
Nur Lisa Zaharan
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Disease Risk ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
Evidence Based ◽  
Age Group ◽  
Converting Enzyme Inhibitors ◽  
Coronary Syndrome ◽  
To Receive

Abstract Background: Octogenarians have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS).Method: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Patients ≥ 80 years old admitted with ACS at 23 participating hospitals from 2008 to 2017 (n=3,080) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies were examined. Binary logistic regression was used.Results: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (53% men, mean age=83.3, SD±3.4) within the 10-year. The largest ethnic group was Chinese (44%). Hypertension (78%) was the main CV risk factor. Most octogenarians (90.4%) have multiple CV risk factors. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p<0.001). Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p<0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less than half were prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blocker (43.0%). From 2008 until 2017, there were positive increments in cardiovascular intervention and pharmacotherapies. Men were more likely to receive PCI than women (Odds Ratio (OR): 0.698; 95%CI: 0.490-0.993). Those with NSTEMI (OR=0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (OR=0.229, 95% CI: 0.143-0.366 were less likely to receive PCI but more likely to be given anticoagulants (NSTEMI, OR=1.543, 95% CI: 1.111-2.142; UA, OR=1.610, 95% CI: 1.120-2.314) than STEMI octogenarians. The presence of cardiovascular risk factors and comorbidities influences management. For example, those with congestive heart failure were more likely to be given PCI and evidence-based pharmacotherapies.Conclusion: Despite being the most vulnerable age group, octogenarians were conservatively treated with evidence-based treatment of ACS. As it is expected that the number of octogenarians with ACS will continue to increase thus the country needs to prepare to improve the management of this specific group of patients.

scholarly journals Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy

2017 ◽  
Vol 7 (7) ◽  
pp. 631-638 ◽  
Author(s):  
Mario Iannaccone ◽  
Fabrizio D’Ascenzo ◽  
Paolo Vadalà ◽  
Stephen B Wilton ◽  
Patrizia Noussan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
Converting Enzyme Inhibitors ◽  
Patients With Cancer ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
One Year

Background: The prevalence and outcome of patients with cancer that experience acute coronary syndrome (ACS) have to be determined. Methods and results: The BleeMACS project is a multicentre observational registry enrolling patients with acute coronary syndrome undergoing percutaneous coronary intervention worldwide in 15 hospitals. The primary endpoint was a composite event of death and re-infarction after one year of follow-up. Bleedings were the secondary endpoint. 15,401 patients were enrolled, 926 (6.4%) in the cancer group and 14,475 (93.6%) in the group of patients without cancer. Patients with cancer were older (70.8±10.3 vs. 62.8±12.1 years, P<0.001) with more severe comorbidities and presented more frequently with non-ST-segment elevation myocardial infarction compared with patients without cancer. After one year, patients with cancer more often experienced the composite endpoint (15.2% vs. 5.3%, P<0.001) and bleedings (6.5% vs. 3%, P<0.001). At multiple regression analysis the presence of cancer was the strongest independent predictor for the primary endpoint (hazard ratio (HR) 2.1, 1.8–2.5, P<0.001) and bleedings (HR 1.5, 1.1–2.1, P=0.015). Despite patients with cancer generally being undertreated, beta-blockers (relative risk (RR) 0.6, 0.4–0.9, P=0.05), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR 0.5, 0.3–0.8, P=0.02), statins (RR 0.3, 0.2–0.5, P<0.001) and dual antiplatelet therapy (RR 0.5, 0.3–0.9, P=0.05) were shown to be protective factors, while proton pump inhibitors (RR 1, 0.6–1.5, P=0.9) were neutral. Conclusion: Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).

scholarly journals Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Siti Z. Suki ◽  
Ahmad S. M. Zuhdi ◽  
‘ Abqariyah A. Yahya ◽  
Nur L. Zaharan
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Angiotensin Receptor Blockers ◽  
Coronary Syndrome ◽  
To Receive ◽  
National Cardiovascular

Abstract Background Octogenarians and beyond have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS) in a multi-ethnic, middle-income country in South East Asia. Method This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Consecutive patient data of those ≥80 years old admitted with ACS at 24 participating hospitals from 2008 to 2017 (n = 3162) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies over the 10-years were examined and compared across groups of interests using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio of receiving individual therapies according to patients’ characteristics. Results Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (mean age = 84, SD ± 3.6) from 2008 until 2017. The largest ethnic group was Chinese (44%). Most octogenarians (95%) have multiple cardiovascular risk factors, with hypertension (82%) being the main. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p < 0.001). Within the 10-year, there were positive increments in cardiovascular intervention and pharmacotherapies. Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p < 0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less being prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blockers (43.0%). Men were more likely to receive PCI than women (adjusted Odds Ratio (aOR): 0.698; 95% CI: 0.490–0.993). NSTEMI (aOR = 0.402, 95% CI: 0.278–0.583) and unstable angina (UA) (aOR = 0.229, 95% CI: 0.143–0.366) were less likely to receive PCI but more likely given anticoagulants (NSTEMI, aOR = 1.543, 95% CI: 1.111–2.142; UA, aOR = 1.610, 95% CI: 1.120–2.314) than STEMI. The presence of cardiovascular risk factors and comorbidities influences management. Conclusion Octogenarians with ACS in this country were mainly treated with cardiovascular pharmacotherapies. As the number of octogenarians with ACS will continue to increase, the country needs to embrace the increasing use of PCI in this group of patients.

scholarly journals Sex disparities in the presentation, management and outcomes of patients with acute coronary syndrome: insights from the ACS QUIK trial

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001470
Author(s):  
Haitham Khraishah ◽  
Barrak Alahmad ◽  
Abdulhamied Alfaddagh ◽  
Sun Young Jeong ◽  
Njambi Mathenge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Adjusted Relative Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Coronary Syndrome ◽  
To Receive

AimsOur aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce.MethodsWe examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation.ResultsA total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001).ConclusionWomen presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.

scholarly journals Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 10 (2) ◽  
pp. 113-120
Author(s):  
Fathima Aaysha Cader ◽  
Afzalur Rahman ◽  
Mohammad Ullah ◽  
Mohammad Arifur Rahman ◽  
Md Sarwar Alam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Young Women ◽  
Young Patients ◽  
Coronary Intervention ◽  
Young Males ◽  
Young Females ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI).Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed.Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15).Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles.Cardiovasc. j. 2018; 10(2): 113-120

scholarly journals Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Priyadarshani Galappatthy ◽  
Vipula Bataduwaarachchi ◽  
Priyanga Ranasinghe ◽  
Gamini Galappatthy ◽  
Upul Senerath ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Sri Lanka ◽  
Disease Risk ◽  
Management Strategies ◽  
Significant Proportion ◽  
Coronary Syndrome ◽  
One Year ◽  
Grace Score

Objective. To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods. Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results. A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p<0.001), diabetes (p<0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p<0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p<0.05). Conclusions. Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.

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