title: Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry.
abstract: OBJECTIVE
  There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India.
  
  
  RESULTS
  We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE.
  
  
  CONCLUSIONS
  These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.
authors.affiliation: Department of Cardiology, Westfort Hi-Tech Hospital, Ltd, P.B. No. 930, Punkunnam, Thrissur 680 002, Kerala, India. drppmohanan@gmail.com
authors.forename: Padinhare Purayil
authors.initials: PP
authors.lastname: Mohanan
authors.forename: Rony
authors.initials: R
authors.lastname: Mathew
authors.forename: Sadasivan
authors.initials: S
authors.lastname: Harikrishnan
authors.forename: Mangalath Narayanan
authors.initials: MN
authors.lastname: Krishnan
authors.forename: Geevar
authors.initials: G
authors.lastname: Zachariah
authors.forename: Jhony
authors.initials: J
authors.lastname: Joseph
authors.forename: Koshy
authors.initials: K
authors.lastname: Eapen
authors.forename: Mathew
authors.initials: M
authors.lastname: Abraham
authors.forename: Jaideep
authors.initials: J
authors.lastname: Menon
authors.forename: Manoj
authors.initials: M
authors.lastname: Thomas
authors.forename: Sonny
authors.initials: S
authors.lastname: Jacob
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors