Acute ST Elevation Myocardial Infarction at Surin Hospital
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Abstract
Background: Acute Coronary Syndrome (ACS) is the results of acute severe ischemic heart disease. In cases of severe or prolong ischemia may cause acute myocardial infarction. According to ACS is one of the major causes of mortality worldwide including Thailand and the incidence prone to increase in the future. The previous study related to acute myocardial infarction patients in 2004 revealed that mortality rate was up to 40%. Therefore Surin hospital had applied ST elevation myocardial infarction (STEMI) guideline to practice since then.
Objectives: To describe patient's demographic data and outcome of applied ST Elevation Myocardial Infarction (STEMI) guideline in Surin hospital
Study design: Descriptive retrospective study
Method: Data collected from patient's chart diagnosed with STEMI and admitted in Surin hospital during October 1st 2006 to September 30th 2007. Statistical analysis of descriptive data presented in frequency, mean and percentile.
Result: From 111 patients diagnosed with STEMI were 82 males and 29 females (ratio 4 :1). Most of patients (84.68%) referred from community hospitals and aged between 71-80 years. Patients mostly visited with symptoms of chest pain and discomfort. Mortality rate was 25.23% and decreased when compared to those of 2004 (43.75%) the year before STEMI guideline was applied. 67.86% of dead cases died within first 48 hours of admission. Infarction often found at site of anterior and inferior wall. The major risk factors were smoking, hypertension and ischemic heart disease. Major complication was cardiac arrhythmias. Streptokinase was prescribed in 35.14% of cases which increased from only 14.58% in 2004. Usage of other medications to prevent mortality considered as low in Aspirin, ACE Inhibitors, ADP inhibitor and Statin group (90.09%, 26.13%, 36.04%, 15.32% and 70.27% respectively). Average length of stay was 5.49 days (maximum 31 days), average total cost per patient was 23,387.67 baht and average cost per patient day was 4,253.32 baht.
Conclusion: After STEMI guideline was applied to practice, mortality rate of admitted patients decreased and usage of medication to prevent mortality during and after admission was not largely prescribed. Furthermore disease information should be provided to patient for early detection and treatment including minimizes risk of myocardial infarction.
Key words: Acute myocardial infarction, ACE inhibitor, ADP inhibitor, Streptokinase
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References
2. Ambrose JA,Winters SL, Arora RR, et al. Coronary angiographic morphology in myocardial infarction : A link between the pathogenesis of unstable angina and myocardial infarction. J Am Coll Cardiol 1985:6:12338.
3. ศูนย์ข้อมูลลารสนเทศและสถิติโรงพยาบาล สุรินทร์, โรงพยาบาลสุรินทร์ ปี 2551. สุรินทร์ : ฝ่ายแผนงานสารสนเทศโรงพยาบาลสุรินทร์ ; 2551.
4. Tunsstall-Pedoe H, Kuulasmaa K, Amougol P. Myocardial infarction and coronary deaths in the World health Organization MONICA project, Circulation 1994;90:583-612.
5. Myocardial infarction redefined- A consensus document of The Joint European Society of cardiology/American College of cardiology committee for the Redefinition of Myocardial infarction. The Joint European Society of cardiology /American college of Cardiology committee. European Heart Journal (2000)21,1502-13.
6. Alpert J S, Thygesen K, Antman E, et al. Myocardial infarction redefined - a consensus document to the Joint European Society of cardiology / American College of Cardiology Committee for the redefinition of myocardial infarction. J Am coll Cardial 2000;36:959-69.
7. ACC/AHA Guideline for the Management of Patients with ST-Elevation Myocardial Infarction : A report of the American College of Cardiology / American Heart Association Task Force on Practice Guideline Committee to revise the 1999 Guideline for the Management of Patients with Acute Myocardial Infarction
8. Jersey C. Martha JR. et al. "American's best hospitals" perform better for acute myocardial infarction? N Engl J Med. 1999;340:286-92.
9. มุกดา สุดงาม, โรคกล้ามเนื้อหัวใจตายเฉียบพลัน ในโรงพยาบาลสุรินทร์. วารสารการแพทย์โรงพยาบาลศรีสะเกษ สุรินทร์ บุรีรัมย์ 2549;21:28-35.
10. Bayer AJ, Chadha JS, Faray RR, et al. Changing presentation of myocardial infarction in increasing old age. J Am Geriate Soc 1986:34:263.
11. The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guideline. Biomarkers of Acute Coronary Syndrome and Heart Failure. Draft Guidelines Version 2. 2004
12. Thai Heart Association of Thailand. Thai ACS Registry https://www.Thaiheart.org/ download(ACS_Registry_Update_10_ Sep_05.pdfc 24 November 2006)
13. Yusuf S, Lessem J, Jhap, et al. Primary and secondary prevention of myocardial infarction and strokes : an update of randomly allocated controlled trials. J Hypertens 1993; 11 (Suppl 4) :S61-S73.
14. Freemantle N, Cleland J, Young P, et al. Beta blockade after myocardial infarction : systematic review and metaregression anlysis. Br Med J 1999;318:1730-7.
15. ACE Inhibitor Myocardial Infarction Collabarative Group. Indication for ACE Inhibitors in the early treatment of acute myocardial infarction : systematic overview of indiducl data from 100,000 patient in randomized trials [see comments]. Circulation 1998;97:2002-12.
16. GISSI-3 : Effect of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Gruppo Italiano per lo Studio della So prawivenzaneir infarcto Myocardico. Lancet 1994;343:1115-22.
17. ISIS-4 : a randomized factorial assessing early oral captopril, oral mononitrate, and intravenous magnesium in 58,050 patients with suspected acute myocardial infarction. ISIS-4 (Forth International Study of Infarct Survival) Collaborative Group. Lancet 1995:345:669-85.
18. The CURE Investigators. Neew England Journal of Medicine 2001 ; 345(7):494-502.
19. CAPRIE Steering Committee. A randomized, blined trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996;348:1329-39.
20. The Scandinavian Simvastatin Survival Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease : The Scandinavian Simvastatin Survival Studt (4S). Lancet 1994;344:1383-9.
21. Snack FM, Pfeffer MA, Moye LA et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol level. Cholesterol and Recurent Events Trial Investigators. N Engl J Med 1996:335:1001-9.
22. The Long-Term Investigation with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998;339:1349-57
23. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group : Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction.l988;ii:349-60.
