Epidemiological Study on Pattern and Outcome of Acute Nstemi Patients in A Tertiary Care Hospital

Abstract

Background: Despite efforts to improve emergency care for patients with acute myocardial infarction (AMI), there has been a paucity of studies outlining real, countrywide patterns in the management of non-ST elevation myocardial infarction (NSTEMI) in EDs. We set out to define NSTEMI, as well as its treatment and implications.

Methods: Forty patients with non-ST-elevation myocardial infarction (NSTEMI) were enrolled in a prospective single-center experiment at Nil Ratan Sircar Medical College & Hospital, Kolkata from May 2022 to July 2023. After 30 days, participants' demographics, medical history, clinical symptoms, laboratory findings, Killip categorizations, electrocardiogram (ECG), echocardiogram (ECHO), diagnostic coronary angiography (CAG), treatment regimens, medicines, and outcomes were documented.

Results: Among the forty patients polled, sixty percent were male and seventy percent were in the age bracket of 56 to seventy (p=0.002). Heart disease (CVD) risk factors included diabetes (n=24, or 60%) and high blood pressure (40%). Of the total instances, only 29 (or 72%) had a prompt presentation (defined as occurring within 6 hours; p=0.0001). With a p-value of only 0.005, 36 patients (or 90%) were placed in Killip class I, whereas 4 patients (10%) were placed in Killip class II. Nobody had their risk scores assessed while they were in the hospital. Although 28 individuals (or 70%) displayed T-wave inversion, all patients' electrocardiograms demonstrated a sinus rhythm. Out of 36 patients who underwent echocardiography, 90% had normal results. However, in 6 patients, or 16.7%, left ventricular systolic dysfunction was detected (p=.003). A median ejection fraction of 52% was found, with a range of 25-75%. There were 38 patients who had stents inserted (95% of the total) after diagnostic CAG, and 23 individuals who did not (58% of the total). For 23 patients (58%) in our study group, heart catheterization was the primary way of end-of-treatment. Aspirin, clopidogrel, parenteral anticoagulation, and ACE and AK inhibitors or blockers were among the numerous drugs provided to each patient. Among those individuals, diuretics were prescribed to seven (17.5%), proton pump inhibitors to twenty-eight (70%), and statins to thirty-eight (95%). In terms of the 30-day outcomes, all patients survived; ten patients, or 25%, were readmitted; and no patients died during their hospital stay or within that time frame.

Conclusion: Negative ST-elevation myocardial infarction was more common in older male patients. It took a long time for most patients to reach the emergency room. Hypertension and diabetes mellitus were major contributors to the risk. Except for one patient's electrocardiogram (ECG) revealing a T-wave inversion, all of the others showed normal sinus rhythm. The standard procedure for NSTEMI, which most patients followed, did not include risk classification. PCI was the main approach to end-of-life care. Readmission occurred in 25% of patients even though there was no mortality in the hospital or in the first 30 days.