MAXIMIZING ACUTE CORONARY SYNDROME OUTCOMES IN THE FACE OF CHALLENGING RESOURCES

Abstract

Unpublished data from in Lady Reading Hospital, a tertiary care hospital in
Peshawar, documented total admissions of 6510 in 2013 to Cardiology
department which consisted of CAD 3766 (57.85%) presenting as STEMI 1733
(46.02%), NSTEMI 483 (12.82%) and USA 750 (19.9%). Others presented as
heart failure or arrhythmias due to RHD, cardiomyopathy or CHD. Mean age of
the patients was 56.7±11.9 years. Gender distribution was males 63.7% and
2 females 36.3%. Mean BMI (kg/m ) was 24.2±3.5, and in males 22.8±4.1 and in
females 26.1±6.5. Mean hospital stay was 4.7±1.9 days, for STEMI 4.9±2.1,
NSTEMI: 3.8±0.9 and UA: 3.7±1.1.

In a study on 200 patients presenting with ACS, TIMI score was compared with coronary angiographic results. Mean age was
58.53±10.64 years. Of them 142 (71%) patients with TIMI score<4 (low and intermediate TIMI risk score) and 58 (29%)
patients with TIMI score>4 (high TIMI risk score). TIMI score>4 more likely to have significant three vessels CAD (62 %)
versus those with TIMI risk score<4 (46.2 %), (p< 0.04). Patients with TIMI score>4 should be referred for early invasive
4 coronary evaluation to derive clinical benefit.

To conclude, in our circumstances emphasis should be on efficient and cost effective primary prevention strategy to reduce or
avoid patients presenting as acute coronary syndrome. Early, widespread and efficient use of Streptokinase has to be made
mandatory. Use of all evidence based therapeutic regimen has to be encouraged to optimize the outcomes. Currently very few
centres, if any, can afford to offer primary PCI to all patients but efforts need to be made in this direction, initially in selected
cases and later for all comers. Selection of patients for interventions based on indications and importantly provision of free
services for emergency interventional services is direly needed with allocation of special funds.