Document Detail


Prognostic value of selected presenting features of acute coronary syndrome in predicting in-hospital adverse events: insight from the Thai Acute Coronary Syndrome Registry.
MedLine Citation:
PMID:  19420808     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the relationship of the presenting features of acute coronary syndrome (ACS) to in-hospital adverse events (total and cardiac deaths, heart failure and serious dysrhythmia) and the effects of coronary intervention. BACKGROUND: Patients with ACS may present with dyspnea, shock and/or cardiac arrest with or without accompanying chest pain. METHODS: We evaluated 9,373 patients (age 65+/-12 years and 60% males) enrolled in the Thai ACS Registry. Cardiac dyspnea included shortness of breath on exertion, and/or at rest, orthopnea, or paroxysmal nocturnal dyspnea presumed from cardiac sources. Shock was present if systolic blood pressure was <90 mmHg for >30 min with symptoms of end-organ hypoperfusion. Post cardiac arrest was identified if cardiopulmonary resuscitation was required. We calculated the frequencies of these presenting features and assessed their contribution toward in-hospital adverse events (total and cardiac deaths, heart failure and serious arrhythmias) for the whole ACS and each entity of ACS and the effects of in-hospital interventions, both coronary and medicinal. RESULTS: Cardiac dyspnea, shock and post cardiac arrest were seen in 32.7%, 9.3%, and 4.2% of patients, respectively. In-hospital adverse events occurred more frequently in patients with these presenting features than those without (p<0.05). Cardiac dyspnea and shock were independent predictors of heart failure and death, respectively, while post cardiac arrest independently identified patients at risk of arrhythmia, total and cardiac death, regardless of the subgroup of ACS. Coronary revascularization significantly reduced the risk of total and cardiac death. CONCLUSION: These 3 presenting features of ACS portend a poor prognosis, regardless of the subgroup of ACS and should be considered as important early indicators for early intervention.
Authors:
Nithima Chaowalit; Tada Yipintsoi; Damras Tresukosol; Rungsrit Kanjanavanit; Songsak Kiatchoosakun;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-01
Journal Detail:
Title:  Internal medicine (Tokyo, Japan)     Volume:  48     ISSN:  1349-7235     ISO Abbreviation:  Intern. Med.     Publication Date:  2009  
Date Detail:
Created Date:  2009-05-07     Completed Date:  2010-02-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9204241     Medline TA:  Intern Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  639-46     Citation Subset:  IM    
Affiliation:
Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sincw@mahidol.ac.th
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis*,  mortality*,  therapy
Aged
Female
Hospital Mortality / trends*
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Registries*
Thailand / epidemiology
Investigator
Investigator/Affiliation:
Nithi Mahanonda / ; Permyos Ruengsakulrach / ; Pakorn Lolekha / ; Boonchu Srichaiveth / ; Gampanat Veerakul / ; Lertlak Chaothawee / ; Sudaratana Tansuphaswadikul / ; Wirash Kehasukcharoen / ; Boonjong Saejueng / ; Taworn Suithichaiyakul / ; Suphot Srimahachota / ; Thanawat Benjanuwattra / ; Rungsrit Kanjanavanit / ; Osthon Sriyadthasak / ; Worachart Moleerergpoom / ; Kasem Ratanasumawong / ; Chumpol Piamsomboon / ; Sopon Sanguanwong / ; Saowaluk Prompongsa / ; Kitiporn Angkasuwapala / ; Napa Siriviwattanakul / ; Supachai Tanomsup / ; Piyamitr Sritara / ; Rangson Ratanaprakarn / ; Chartchai Suntiparpluacha / ; Damras Tresukosol / ; Wiwun Tungsubutra / ; Woravut Jintapakorn / ; Songkwan Silaruks / ; Songsak Kiatchoosakul / ; Chaiyasit Wongvipaporn / ; Pisit Hutayanon / ; Adisai Buakhamsri / ; Sawaet Nontakanun / ; Kajorn Khaopaisarn / ; Navin Suraphakde / ; Watana Boonsom / ; Sopon Krisanarungson /

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