Acute Coronary Syndrome in 1,366 Patients at Siriraj Hospital: Clinical Characteristics, Management and In-Hospital Outcomes
Wiwun Tungsubutra MD*, Damras Tresukosol MD*, Rungroj Krittayaphong MD*, Pradit Panchavinnin MD*, Chunhakasem Chotnaiwattarakul MD**, Rewat Phankingtongkhum MD*
Affiliation : * Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok ** Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objective : To characterize the baseline characteristics, management and in-hospital outcomes of all patients
admitted with acute coronary syndrome (ACS).
Materials and Methods : The present study is a prospective, observational study of all consecutive patients
admitted with ACS. From August 1, 2002 through October 31, 2005, data from 1,366 ACS patients were
collected.
Results : The patients were classified according to the final discharge diagnosis as ST-segment elevation
myocardial infarction (STEMI, 33.5%), non-ST-segment elevation myocardial infarction (NSTEMI, 47%) and
unstable angina (UA, 19.5%). Approximately half of the patients were older than 65 years old. The STEMI
patients were significantly younger and had a higher percentage of men than the NSTE-ACS patients. There
was a very high prevalence of diabetes, hypertension and dyslipidemia in the patients. Only 60% of the STEMI
patients received reperfusion therapy. Of these, primary percutaneous coronary intervention (PCI) was per-
formed more frequently (35%) than thrombolytic therapy (24%). There were substantial delays in time to
treatment. Median door to needle and door to balloon time were 135 and 130 minutes respectively. Half of the
NSTEMI and UA patients underwent coronary angiography and about one-third had PCI or coronary artery
bypass grafting in the same hospital admission. In-hospital mortality rate was high: STEMI 19%, NSTEMI
16% and UA 4%.
Conclusion : The present study provides invaluable information regarding the spectrum of ACS in our country.
Overall in-hospital mortality was higher than that reported from international registries. The present findings
represent a significant opportunity for quality improvement in the care of patients with ACS and the imple-
mentation of preventive strategies for patients with and at risk for coronary artery disease.
Keywords : Acute coronary syndrome, ST-segment elevation myocardial infarction, Non-ST-segment elevation myocardial infarction, Unstable angina
