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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 170-173

Influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome in a tertiary care center


1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
2 Department of Cardiology, National Heart Institute, Shebin El Kom, Egypt
3 Department of Cardiology, Shebin El Kom Teaching Hospital, Shebin El Kom, Egypt

Date of Submission02-Apr-2019
Date of Decision07-May-2019
Date of Acceptance20-May-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Amr I El-Sayed
Quesna, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_149_19

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  Abstract 


Objective
The aim of this study is to assess the influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome.
Background
Cardiovascular disease is the cause of death in 55% of women compared with 43% of men. Acute coronary syndrome risk factors increase the likelihood of disease. Clinical research studies have demonstrated that effective risk factor reduction results in decreases in acute coronary syndrome morbidity and mortality.
Patients and methods
This is a cross-sectional study in which data were collected from September 2015 to September 2016. The study included 207 patients admitted in Cardiology Department, National Heart Institute, Egypt, chosen by simple random sample technique. A case record form was used that included modifiable and nonmodifiable risk factors, physical findings, investigations, diagnosis, interventional procedures, and in-hospital outcome.
Results
In this study, it was noticed that left ventricular (LV) dysfunction was the most frequent outcome: 13% for moderate reduction in LV function and 6% for severe reduction. Overall, 53.6% of those who developed mild to moderate LV dysfunction and 69.2% of those with severe LV dysfunction were diabetics. There was no statistically significant difference regarding death between ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. There is a significant association between death and positive family history of ischemic heart disease (P = 0.05).
Conclusion
The results of this study have demonstrated that there was a significant association between death and positive family history of ischemic heart disease (P = 0.05).

Keywords: acute coronary syndrome, in-hospital outcome, risk factors, women


How to cite this article:
Reda AA, El Kersh AM, Kazamal GA, El-Sayed AI. Influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome in a tertiary care center. Menoufia Med J 2021;34:170-3

How to cite this URL:
Reda AA, El Kersh AM, Kazamal GA, El-Sayed AI. Influence of risk factors on in-hospital outcomes in women presenting with acute coronary syndrome in a tertiary care center. Menoufia Med J [serial online] 2021 [cited 2021 May 8];34:170-3. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/170/311993




  Introduction Top


Ischemic heart disease (IHD) is the leading killer of women of all ages, with annual mortality rates affecting greater numbers of younger and older women than breast cancer. In the USA, more than a quarter of a million women die each year from IHD, and current projections indicate that this will increase with our aging population and epidemics of obesity, metabolic syndrome, and diabetes mellitus [1].

Cardiovascular disease (CVD) is the cause of death in 55% of women compared with 43% of men. Aspects such as clinical course features, symptoms, main pathogenetic mechanisms, and effects of pharmaceutical substances have been proven to be different between males and females, and these differences should be taken into account during primary and secondary prevention of coronary artery disease [2].

Among patients with IHD, women experience relatively worse outcomes ranging from stable angina to acute coronary syndromes (ACS) and heart failure compared with men [3].

This work aimed to assess the influence of risk factors on in-hospital outcomes in women presenting with ACS.


  Patients and methods Top


This is a cross-sectional study that was conducted on all women fulfilling the diagnostic criteria of ACS (according to chest pain, ECG, and cardiac enzymes) admitted in Cardiology Department, National Heart Institute, Egypt. Data were collected from September 2015 to September 2016.

Sampling

The study group was chosen by convenient sample technique.

Size of study group

The minimal calculated sample size was 200. Data were collected from 220 female patients; 13 of them were excluded owing to incomplete data. The total number of women in the study was 207.

Data collection

A case record form was used. It included the following:

  1. Risk factors included modifiable and nonmodifiable
  2. Physical findings included vital data and cardiac, chest, abdominal, and neurological examinations
  3. Investigations included cardiac enzymes (CK-MB and troponin), ECG, echocardiography, and coronary angiography
  4. Diagnosis included unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI)
  5. Interventional procedures included percutaneous coronary intervention (PCI)
  6. In-hospital outcomes [left ventricular (LV) dysfunction, mechanical complications, stroke, bleeding, slow flow, and persistent chest pain].


Statistical analysis

The collected data were tabulated and analyzed using the statistical package for the social sciences, version 20.0 [SPSS Inc., Chicago, Illinois, USA) and its licensors 1989.2011]. Categorical data were expressed as number and percentage. Continuous data were expressed as mean and SD. Suitable tests of significance were calculated. Comparison between groups was done using the χ2-test or Fisher's exact test, for categorical data, and Student t-test or analysis of variance (F) test when suitable for continuous data. The accepted level of significance in this work was 0.05 (P ≤ 0.05).


  Results Top


The results of this study show that 14% of the surveyed female patients were smokers, 48.8% were hypertensive, and 24.2% were obese, and only 5.3% of them had a history of peripheral vascular disease. It was noticed that 30.4% had dyslipidemia. Diabetics constituted 56.5% of the sample, whereas 25.1% had a positive family history of IHD. The mean age of the studied females was ∼60 years [Table 1].
Table 1: Frequency distribution of some risk factors among the studied group

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This study revealed that most of the studied females (90.8%) had sinus rhythm, 58% had STEMI, and 58.9% had elevated troponin level. It was noticed that 88.4% of the studied women had undergone PCI, and only 18.8% of them had undergone thrombolytic therapy [Table 2].
Table 2: Frequency distribution of some diagnostic and management characteristics among the studied group

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Most of the studied women (80.2%) had normal LV function. It was noticed that only 0.5% had stroke, 1.9% died, and 3.4% had a slow flow rate. It was noticed that a minority of the studied women had bleeding, mechanical complications, and persistent chest pain (0.5, 2.4, and 0.5%, respectively; [Table 3]).
Table 3: Frequency distribution of some complications among the studied group

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There is a significant association between death and positive family history of IHD (P = 0.05; [Table 4]).
Table 4: Frequency distribution of the studied group according to death and some risk factors

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  Discussion Top


The risk of CVD in women has been historically underestimated owing to a misperception that women are protected against CVD. Nowadays, it is known that CVD is the number one killer of women in the USA and worldwide.

More than half of the studied women (56.5%) were diabetics; these results are similar to the results of Nishizaki et al. [4] who stated that 40.7% of the studied group were diabetics.

It was noted that 14% of the surveyed women in this study were smokers. These results were similar to the results of a registry study, the Coronary CT Angiography Evaluation for Clinical Outcomes (An International Multicenter were followed for 5 years) registry, in which 5632 patients (36.5% were women) were followed up and revealed that 15% of the studied women were smokers [5]. Approximately half of the studied women (48.8%) were hypertensive; this percentage is lower than that of a study of sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease in which 66.6% were hypertensive [6]. This difference may be owing to undiagnosed cases in our society. The results of this study revealed that, among the events that were assessed in this study (in-hospital LV dysfunction, stroke, death, slow flow, bleeding, mechanical complications and persistent chest pain), it was noticed that LV dysfunction was the most frequent: 13% for moderate reduction in LV function and 6% for severe reduction. This was supported by the results of Alonso et al. [7] who stated that the most frequent event among those that occurred during the patients' hospitalization was heart failure, which occurred in almost one-fourth of the patients.

The results thus obtained showed that there was a significant association between death and family history of IHD (P = 0.05). This correlated with Epidemiological Profile for Acute Coronary Syndrome in which data were collected between October 2003 and December 2010 from patients who were admitted in the ICU of Hospital Santa Lucia, a private institution in Brasilia-DF, Brazil with the diagnosis of ACS for the study of in-hospital mortality, in which the risk factors such as age and family history were important because their presence influences the mortality of each case [8].

There was no statistically significant association between death and hypertension. This finding was supported by a study in which various clinical variables were analyzed to determine their effect on in-hospital mortality and short-term (28-day) mortality rates and revealed that, among the patients with NSTEMI-ACS, it was observed that hypertension did not influence mortality rates [7].

Although this study showed that there was no statistically significant difference regarding death among those who underwent PCI and those who did not, it was noticed that 88.2% of those who survived had undergone PCI. This was similar to a study for analysis of outcomes of percutaneous coronary intervention in patients with metastatic cancer with ACS over a 10-year period and stated that there was no significant difference in mortality between patients who underwent PCI and those who did not. This has remained unchanged for patients with STEMI [9].

Although the results thus obtained showed that there was no statistically significant association between LV dysfunction and smoking, hypertension, diabetes mellitus, obesity, dyslipidemia, and family history of IHD (P > 0.05), it was found that 53.6% of those who developed mild to moderate LV dysfunction and 69.2% of those with severe LV dysfunction were diabetics. This came in concordance with American Diabetes Association [10] which stated that as many as 50% of patients with type 2 diabetes may develop heart failure.


  Conclusion and recommendations Top


In this study, it was noticed that LV dysfunction was the most frequent outcome. There was no statistically significant difference regarding death between STEMI and NSTEMI. The results of this study have demonstrated that there was a significant association between death and positive family history of IHD (P = 0.05). PCI can reduce mortality among women with ACS as 88.2% of those who survived had undergone PCI.

On the highlight of the results of this study, it is highly recommended to raise the public awareness of importance of positive family history of IHD and early screening and complete CVD risk assessment in women. More studies in women with ACS are needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Merz CN. Women and ischemic heart disease paradox and patho-physiology. JACC Cardiovasc Imaging 2011; 4:74–77.  Back to cited text no. 1
    
2.
Sharma K, Gulati M. Coronary artery disease in women. Glob Heart 2013; 8:105–112.  Back to cited text no. 2
    
3.
Davis MB, Maddox TM, Langner P, Plomondon ME, Rumsfeld JS, Duvernoy CS. Characteristics and outcomes of women veterans undergoing cardiac catheterization in the Veterans Affairs Health care System: insights from the VACART Program. Circ Cardiovasc Qual Outcomes 2015; 8:S39–S47.  Back to cited text no. 3
    
4.
Nishizaki Y, Miyauchi K, Okazaki S, Tamura H, Iwao O, Ogita M, et al. Prospective validation of the Bleeding Academic Research Consortium classification in the all-comer PRODIGY trial. Eur Heart J 2014; 35:2524–2529.  Back to cited text no. 4
    
5.
Schulman-Marcus J, Hartaigh B, Gransar H, Lin F, Valenti V, Cho I, et al. Sex-specific associations between coronary artery plaque extent and risk of major adverse cardiovascular events: the CONFIRM long-term registry. JACC Cardiovascular Imaging 2016; 9:364–372.  Back to cited text no. 5
    
6.
Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease: insights from the PROMISE trial. JACC Cardiovascular Imaging 2016; 9:337–346.  Back to cited text no. 6
    
7.
Alonso J, Bueno H, Bardají A, García-Moll X, Badia X, Layola M, et al. Influence of sex on acute coronary syndrome mortality and treatment in Spain. Rev Esp Cardiol 2010; 8:8–22.  Back to cited text no. 7
    
8.
Vargas LA, Boin AC, Santiago RA, Corrêa FG. Epidemiological profile for acute coronary syndrome: the difference between genders in an intensive care unit. J Hypertens 2013; 2:120.  Back to cited text no. 8
    
9.
Guddati AK, Joy PS, Kumar G. Analysis of outcomes of percutaneous coronary intervention in metastatic cancer patients with acute coronary syndrome over a 10-year period. J Cancer Res Clin Oncol 2016; 142:471–479.  Back to cited text no. 9
    
10.
American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in diabetes. Diabetes Care 2018; 41:86–104.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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