Title: Immediate outcomes of Acute Coronary Syndrome: A hospital-based prospective observational study in a tertiary care institute in West Bengal, India

Authors: Dr Suman Biswas, Dr Biswanath Sharma Sarkar, Dr Shuvankar Mukherjee, Dr Nabanita Bhattacharyya

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.06

Abstract

     

Introduction: Death due to Cardiovascular morbidities is one of the biggest health burden in India as well as worldwide. It is important to know the factors that may influence the outcome of the patients with Acute Coronary Syndromes (ACS).

Methods: A total of 112 patients with diagnosed ACS admitted at the Department of Cardiology in a tertiary care institute in West Bengal, India were monitored from the time of admission to the discharge or outcome. They were measured for several anthropometric parameters like height, weight, body fat percentage, BMI, waist circumference etc. and various other biochemical and cardiovascular tests were done, and they were noted for the outcome in terms of recovery following discharge or death, for a maximum of 10 days post-ACS. The data were analyzed by SPSS 20 and Kaplan- Meier survival analysis was done.

Results: Most common ACS was found to be left anterior descending artery ST segment elevated myocardial infarction (STEMI) (68.7%). Mortality observed during the 10-day observation period was 16.1%. Mortality rate did not vary significantly with the type of ACS (p = .899). Survival Analysis showed that there were significantly more chances of survival in the patients with percutaneous coronary intervention (PCI) in comparison with the patients who received only thrombolysis in the beginning of the time (p = .019) and at the end of the observation period (p = .037). The survival curves for patients based on BMI, waist circumference and body fat percentage did not vary significantly (p >.05).

Conclusion: It could be concluded from the present study that survival after ACS significantly associated with PCI and not with obesity or overweight.

Keywords: acute coronary syndrome, percutaneous coronary intervention, body fat percentage, survival analysis.

References

  1. Cardiovascular diseases (CVDs) [Internet]. World Health Organization. 2018 [cited 29th Nov 2018]. Available from: http://www.who.int/cardiovascular_diseases/en/
  2. Gupta R, Mohan I, Narula J. Trends in Coronary Heart Disease Epidemiology in India. Annals of Global Health. 2016; 82(2):307.
  3. Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India. Circulation. 2016;133(16):1605-20.
  4. World Health Organization. (2000) Obesity: Preventing and Managing the Global Epidemic. World Health Organization Geneva, Switzerland.
  5. Kopelman, P. G. (2000) Obesity as a medical problem. 404: 635–43.
  6. Seidell, J. C., Flegal, K. M. (1997) Assessing obesity: classification and epidemiology. Br Med Bull.53: 238–52.
  7. Expert Panel on the Identification Evaluation and Treatment of Overweight in Adults (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr.68: 899–9
  8. Kumar A, Cannon CP. Acute Coronary Syndromes: Diagnosis and Management, Part I. Mayo Clinic Proceedings. 2009;84(10):917-38.
  9. Lavie C, Milani R, Ventura H. Obesity and Cardiovascular Disease. Journal of the American College of Cardiology. 2009;53(21):1925-32.
  10. Patel N, Elsaid O, Shenoy A, Sharma A, McFarlane S. Obesity paradox in patients undergoing coronary intervention: A review. World Journal of Cardiology. 2017;9(9):731-736.
  11. Smith, C., Dixon, R., Wynne, A., Theodorou, L., Ong, S., Subrayan, S., Davidson, S., Hausenloy, D. and Yellon, D. (2010). Leptin-induced cardioprotection involves JAK/STAT signaling that may be linked to the mitochondrial permeability transition pore.American Journal of Physiology-Heart and Circulatory Physiology, 299(4), pp.H1265-H1270.
  12. Shibata R, Kondo K, Ouchi N, Walsh K, Murohara T. Impact of a Single Intracoronary Administration of Adiponectin on Myocardial Ischemia/ Reperfusion Injury in Pig Model. Journal of Cardiac Failure. 2009;15(7).
  13. Tao L, Gao E, Jiao X, Yuan Y, Li S, Christopher T et al. Adiponectin Cardioprotection After Myocardial Ischemia/Reperfusion Involves the Reduction of Oxidative/Nitrative Stress. Circulation. 2007;115(11):1408-16.
  14. Gao J, Chang Chua C, Chen Z, Wang H, Xu X, C. Hamdy R et al. Resistin, an adipocytokine, offers protection against acute myocardial infarction. Journal of Molecular and Cellular Cardiology. 2007;43(5):601-609.
  15. Shibata R, Sato K, Pimentel D, Takemura Y, Kihara S, Ohashi K et al. Adiponectin protects against myocardial ischemia-reperfusion injury through AMPK- and COX-2–dependent mechanisms. Nature Medicine. 2005;11(10):1096-1103.
  16. Shibata R, Ouchi N, Ito M, Kihara S, Shiojima I, Pimentel D et al. Adiponectin-mediated modulation of hypertrophic signals in the heart. Nature Medicine. 2004;10(12):1384-1389.
  17. Smith C, Mocanu M, Davidson S, Wynne A, Simpkin J, Yellon D. Leptin, the obesity-associated hormone, exhibits direct cardioprotective effects. British Journal of Pharmacology. 2006;149(1):5-13.
  18. Gorodezky C. Genetic Difference between Europeans and Indians: Tissue and Blood Types. Allergy and Asthma Proceedings. 1992;13(5):243-50.
  19. Misra A. Ethnic-Specific Criteria for Classification of Body Mass Index: A Perspective for Asian Indians and American Diabetes Association Position Statement. Diabetes Technology & Therapeutics. 2015;17(9):667-671.
  20. Singh S, Sikri G, Garg M. Body Mass Index and Obesity: Tailoring “cut-off” for an Asian Indian Male Population. Medical Journal Armed Forces India. 2008;64(4):350-353.
  21. Nuttall F. Body Mass Index. Nutrition Today. 2015;50(3):117-28.
  22. Jackson AS, Pollock ML. Practical assessment of body composition. The Physician and Sportsmedicine. 1985 May 1;13(5):76-90.
  23. Durnin JV, Womersley JV. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British journal of nutrition. 1974 Jul;32(1):77-97.
  24. Siri WE. The gross composition of the body. Adv Biol Med Phys. 1956 Jan 1;4(239-279):513.
  25. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part II. In Mayo Clinic Proceedings 2009 Nov 1 (Vol. 84, No. 11, pp. 1021-1036). Elsevier.
  26. Antman EM. ST‐Elevation Myocardial Infarction. The AHA guidelines and scientific statements handbook. 2008 Dec 12:46-90.
  27. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and .... Journal of the American College of Cardiology. 2007 Aug 14;50(7):e1-57.
  28. Ulijaszek S. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Pp. 252. (World Health Organization, Geneva, 2000.) SFr 56.00, ISBN 92-4-120894-5, paperback. Journal of Biosocial Science. 2003; 35(4):624-25.
  29. Nutrition [Internet]. World Health Organization. 2018 [cited 28 October 2018]. Available from: http://www.who.int/nutrition/en/
  30. Muth N. What are the guidelines for percentage of body fat loss? [Internet]. Acefitness.org. 2018 [cited 31 October 2018]. Available from: https://www.acefitness.org/education-and-resources/lifestyle/blog/112/what-are-the-guidelines-for-percentage-of-body-fat-loss
  31. Bakhoum, S., Sorour, S., Elramly, M., Raslan, H. and Salama, I. (2015). Impact of waist circumference on hospital outcome and coronary angiographic findings of patients with acute ST-segment elevation myocardial infarction. The Egyptian Heart Journal, 67(2), pp.159-165.
  32. Romero-Corral A, Montori V, Somers V, Korinek J, Thomas R, Allison T, et al. (2006). Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. The Lancet 2006; 368 (9536): 666 – 78.
  33. McAuley P, Myers J, Abella J, Froelicher V. Body mass, fitness and survival in veteran patients: another obesity paradox? Am J Med 2007; 120: 518 –24.
  34. Angerås O, Albertsson P, Karason K, Råmunddal T, Matejka G, James S et al. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. European Heart Journal. 2012;34(5):345-53.
  35. Dagenais G, Yi Q, Mann J, Bosch J, Pogue J, Yusuf S. Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. American Heart Journal. 2005;149(1):54-60.

Corresponding Author

Dr Biswanath Sharma Sarkar

Associate Professor, Dept. of General Medicine, Diamond Harbour Government Medical College & Hospital, West Bengal, India