title: Presentation and outcome of patients with acute coronary syndromes in eastern Nepal.
abstract: BACKGROUND
  The burden of ischemic heart disease (IHD) in developing countries is on the rise, due to urbanisation, industrialisation and the low availability of evidence based therapies and interventions.
  
  
  OBJECTIVE
  Data was collected on consecutive patients admitted with acute coronary syndrome (ACS), from 1st January to 31st December 2008, to a tertiary care centre in eastern Nepal. Final diagnosis, risk factors, educational status, time delays, treatment and in-hospital outcomes were evaluated.
  
  
  RESULTS
  A total of 153 patients with ACS were admitted in 2008: 58 with ST elevation myocardial infarction (STEMI) (38%), 28 with non-ST elevation myocardial infarction (NSTEMI) (18%) and 67 with unstable angina (UA) (44%). 40% of patients with STEMI presented within 12 hours of symptom onset. Most patients presented late and 33% of them presented after 2 days or more. Over half the patients were not literate. Due to the unavailability of percutaneous coronary intervention (PCI) at the centre, thrombolysis with Streptokinase was considered for patients presenting with STEMI up to 24 hours after symptom onset. However, due to financial constraints, only 53% of patients in this broadened time window actually received thrombolytic treatment. The in-hospital mortality was 14% for all patients with ACS, and 17% for the patients with STEMI.
  
  
  CONCLUSIONS
  Only a small proportion of patients with ACS in Eastern Nepal are admitted to hospital, and those who are often arrive late, or cannot afford optimal medical management. Awareness, better referral and transport facilities, financial support for the needy, and the availability of on-site coronary angiography and angioplasty for selected patients should contribute to treat more ACS patients and improve their prognosis.
authors.affiliation: Department of Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Nikesh Raj
authors.initials: NR
authors.lastname: Shreshta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basnet
authors.forename: Rupak
authors.initials: R
authors.lastname: Bhandari
authors.forename: Pramod
authors.initials: P
authors.lastname: Acharia
authors.forename: Prahlad
authors.initials: P
authors.lastname: Karki
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D000368:Aged; D003422:Critical Care; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D017063:Outcome Assessment, Health Care; D012307:Risk Factors