National Heart Institute Acute Coronary Syndrome Registry

Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary artery disease [1] , registries and surveys have the potential to define the 'gaps' between evidence and practice as well as implementation of guidelines [2] . Aim of the Work: To assess the application of a newly designed registry among Egyptian patients with ACS and to compare the results with those of other international registries. Methods: The study included 401 patients having acute coronary syndrome admitted to the National Heart Institute CCU over 6 months from January 2007 to June 2007 that were subjected to full history & clinical examination, 12 leads, ECG, and echocardiography. Patients were classified according to the ECG at presentation into ACS with ST elevation, ACS Abbreviations: ACS = Acute Coronary Syndrome NHI = National Heart Institute HTN = Hypertension DM = Diabetes Mellitus ER = Emergency Room MI = Myocardial infraction CABG = Coronary artery Bypass Graft. PCI = Percutaneous Coronary Intervention. CCS = Canadian Cardiovascular Society Classification RBBB = Right Bundle Branch Block ABP = Arterial Blood Pressure. MR = Mitral Regurgitation VSD = Ventricular Septal Defect. TR = Tricuspid Regurgitation LV EF = Left Ventricular Ejection Fraction. LVEDD = Left ventricular end diastolic diameter LVESD = Left ventricular end systolic diameter FS = Fraction shortening SV = Stroke volume EDV = End diastolic volume ESV = End systolic volume CHF = Congestive Heart Failure. LVH = Left ventricular Hypertrophy. IHD = Ischemic Heart Disease Correspondence to: Dr. Wael El Kilany, Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, E-mail: [email protected] without ST Elevation, and ACS with undetermined ECG changes. Patients were managed according to the ACC/AHA guidelines 2004 for STEMI & update 2002 for unstable angina and NSTEMI, In hospital MACE; death, re-infarction, target vessel revascularization and rrhythmias were assessed. Results: ACS with ST elevation was the most common presentation (59.1 %), age of our study population ranges from 18 to 88 years old (54.5 ± 11.9 years). Most of patients were males (79%), smoking was the most significant risk factor (61 %) followed by Hypertension (55%). The main presenting symptom was typical anginal chest pain (91.5%). Coronary angiography was performed in 40% of our study population with higher incidence among patients who had ACS with undetermined ECG changes (44.12%), however reperfusion by PCI was undertaken in a higher percentage of patients with ACS with ST elevation (30.38%). In patients diagnosed as STEMI (267 patients), 65.5% of the patients received thrombolysis “Streptokinase”, while 12.4% were referred for primary PCI. Heart failure was the most prevalent in hospital complication, Atrial fibrillation was the most common occurring arrhythmia. Conclusions: Smoking & hypertension are significant risk factors among Egyptian patients. The use of invasive strategy was restricted to the most critical patients; this was because of financial causes.