Acute coronary syndrome in young patients in Hospital Universiti Sains Malaysia and factors associated with its complications
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Date
2013
Authors
Che’ Muda, Che Muzaini
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Coronary vascular diseases are the main causes of mortality and morbidity in Malaysia. In year 2006, the estimated incidence of acute coronary syndrome (ACS) in Malaysia was 141 per 100,000 population, and the inpatient mortality rate was approximately 7%. Although ACS occurs mainly in older patients, about 5 to 10% of cases occur in young patients aged less than 45 years old causing considerable morbidity and affecting the quality of life in their most productive life. Studies on ACS in young patients in Malaysia are limited and thus the result of this study will hopefully applicable for further reference and research for the benefits of patients. This study was aimed to identify the characteristics, treatment and complications of ACS in young patients aged less than 45 years old admitted in Hospital Universiti Sains Malaysia (HUSM) and the factors associated with its complications. This study was a retrospective record review. Young patients aged less than 45 years old who diagnosed with ACS and admitted to HUSM between 1st of January 2002 to 31st of December 2012 who fulfilled the inclusion and exclusion criteria were included in the study. The data information were collected using a checklist performa designed by researcher consisted of socio-demography, medical history, clinical presentation, laboratory investigation and diagnosis, treatment and complications. Simple and Multiple logistic regressions were used for data analysis. A total of 147 patients were enrolled, with mean (standard deviation) age of 39.1 (4.97) years and male to female ratio of 3:1. Of total sample, 64.6% were diagnosed as unstable angina, 15.6% as non ST elevation myocardial infarction and 19.7% as ST elevation myocardial infarction. The most frequent risk factors of ACS were dyslipidaemia (65.3%), followed by hypertension (43.5%), current smoking (42.9%) and heart disease (29.9%). Most patients treated medically with 91.8% patients received aspirin and statin, and 86.4% received clopidogrel while streptokinase were
prescribed in 11.6% of patients, heparin in 46.3% and fondaparinux in 52.4%. There were 73 patients (49.7%) had complication(s) of ACS with the most common were heart failure, (35.4%) followed by arrhythmia (20.4%) and pulmonary oedema and cardiogenic shock (both 13.6%). Current smokers [adjusted odds ratio (AOR) 4.03; 95% confidence interval (CI): 1.33, 12.23; p value = 0.014], diabetic mellitus [AOR 3.03; 95% CI: 1.19, 7.71; p value = 0.020], and pharmacological treatments of fondaparinux [AOR 0.18; 95% CI: 0.08, 0.39; p value < 0.001] and oral nitrates [AOR 0.18; 95% CI: 0.08, 0.42; p value < 0.001] were the significant associated factors for complications of ACS in young patients admitted in HUSM when other variables were controlled. In conclusion, there was high prevalence of established cardiovascular risk factors in which indicating the importance of primary prevention. Most patients treated medically and heart failure was the most common complication. Smoking status and diabetes mellitus were the significant risk factors while pharmacological treatment of fondaparinux and oral nitrates were the significant protective factors for complications in ACS in young patients admitted in HUSM.
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Keywords
Coronary vascular diseases