DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20222373
Published: 2022-09-27

Recent trends in the pattern and long-term management strategy of patients diagnosed with acute coronary syndrome in India: an observational study

Mithilesh Nayak, Dixit Patel, Alok Chaturvedi, Ankita Shah

Abstract


Background: The understanding of demographic patterns and the real-world management practices for patients with acute coronary syndrome (ACS) will facilitate optimizing the management strategies for ACS based on the patient’s clinical profile and the associated risk factors in Indian patients. Hence, this study determined the demographic details and the treatment patterns in Indian patients with ACS.

Methods: The RECent trends in the pattern and lOng-term management stRategy of patients Diagnosed with acute coronary syndrome in India (RECORD ACS-2) study was a real-world, retrospective, cross-sectional, observational study conducted at various centres across India between 2021 and 2022. The study outcomes included the demographic profile and therapeutic management in patients with ACS.

Results: A total of 9945 patients with a mean age of 59 years were included. The ACS was commonly observed in the age group of 41-70 years with highest incidence in the age group of 51-60 years. The ST-elevation myocardial infarction (STEMI) was most common (53.2%) presentation. Hypertension (37.2%) and dyslipidemia (29.3%) followed by diabetes (21.3%) were the most common comorbidities. Single vessel disease was the most common angiographic feature (58%). Percutaneous coronary intervention was the most preferred management strategy (57%). Ticagrelor was the most preferred loading (68.3%) as well as maintenance (71.2%) P2Y12 inhibitor in ACS patients. Most of the patients (81.8%) had received high intensity statin therapy for the secondary prevention of the disease.

Conclusions: The prevalence of ACS was high between 51-60 years of age, more so in males, smokers, and physically less active patients. Associated comorbidities were hypertension, dyslipidemia and diabetes. Incidence of STEMI was high, and more than half of the patients underwent PCI. Ticagrelor was the most preferred P2Y12 inhibitor in ACS patients for loading as well as maintenance therapy.


Keywords


ACS, STEMI, Cardiovascular, Coronary artery disease

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References


Isezuo S, Subban V, Krishnamoorthy J, Pandurangi UM, Janakiraman E, Kalidoss L et al. Characteristics, treatment and one-year outcomes of patients with acute coronary syndrome in a tertiary hospital in India. Indian Heart J. 2014;66:156-63.

Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94:16-26.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-52.

Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435-42.

Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144:e368-454.

Kaul U, Sethi A, Arambam P, Omar AK, Keshava R, Roy S et al. Safety of Prasugrel in Indian patients - multicentric registry of 1000 cases. Indian Heart J. 2014;66:598-601.

Schüpke S, Neumann F-J, Menichelli M, Mayer K, Bernlochner I, Wöhrle J et al. Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med. 2019;381:1524-34.

Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34:121-9.

Seetharama N, Mahalingappa R, GK RK, Veerappa V, CL A. Clinical profile of acute myocardial infarction patients: a study in tertiary care centre. Int J Res Med Sci. 2017;3:8.

Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet. 2000;356:279-84.

Siddiuqi AH, Kayani AM. Acute myocardial infarction-clinical profile of 1000 cases. Age. 2000;56:11-48.

Hafeez S, Javed A, Kayani AM. Clinical profile of patients presenting with acute ST elevation myocardial infarction. J Pak Med Asso. 2010;60:190.

Vaidya CV, Majmudar DK. A study of clinical profile of acute ST elevation myocardial infarction patients from GMERS Medical College and Hospital, Gandhinagar, Gujarat. 2014;1.

Ajay VS, Prabhakaran D. Coronary heart disease in Indians: Implications of the INTERHEART study. Indian J Med Res. 2010;132:561.

Steg PG, Goldberg RJ, Gore JM, Fox KA, Eagle KA, Flather MD et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 2002;90:358-63.

Misiriya K, Sudhayakumar N, Khadar SA, George R, Jayaprakasht V, Pappachan JM. The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala. J Assoc Physicians India 2009;57:377-83.

Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart J. 2008;60:B4-18.

Al-Delaimy WK, Manson JE, Solomon CG, Kawachi I, Stampfer MJ, Willett WC et al. Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus. Arch Intern Med. 2002;162:273-9.

Seetharama N, Mahalingappa R, Ranjith KG, Veerappa V, Aravindh C. Clinical profile of acute myocardial infarction patients: a study in tertiary care centre. 2015;1-2.

Mandal S, Saha JB, Mandal SC, Bhattacharya RN, Chakraborty M, Pal PP. Prevalence of ischemic heart disease among urban population of Siliguri, West Bengal. Indian J Comm Med Indian Asso Prev Social Med. 2009;34:19.

Mitra A, Pradhan R, Mukherjee S. Importance of heart-healthy diet. J Human Ecol. 2009;27:53-61.

Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Prev Cardiol. 2008;15:247-57.

Nocon M, Hiemann T, Müller-Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Prevent Cardiol. 2008;15:239-46.

Rogers WJ, Canto JG, Lambrew CT, Tiefenbrunn AJ, Kinkaid B, Shoultz DA et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol. 2000;36:2056-63.

Hasdai D, Behar S, Wallentin L, Danchin N, Gitt A, Boersma E et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin. The Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J. 2002;23:1190-201.

Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G et al. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27:2285-93.

Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333:1091.

Butt TS, Bashtawi E, Bououn B, Wagley B, Albarrak B, Sergani HE et al. Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2020;40:281-9.

Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P et al. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J. 2017;69(1):S63-97.

Motkuri V, Mishra RN. Pharmaceutical Market and Drug Price Policy in India. Rev Develop Change. 2020;25:30-53.