Predictors of outcomes of acute coronary syndrome in women admitted in the coronary care unit, cardiovascular unit and medical ICU of a tertiary hospital from January 2015 to December 2020
Authors: Estepa L , De Lara A C 
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Acute Coronary Syndrome (ACS) is a leading cause of demise in the Asia-Pacific region. Women, especially those more than 65 years old, do not seek treatment immediately because symptoms are usually atypical. A study done in the Philippines showed a 100% prevalence of obstructive coronary artery disease (CAD) among women with ACS who underwent cardiac catheterization.

Purpose

To investigate the demographic and clinical profiles, risk factors, laboratory and diagnostic exam results, and correlation of these parameters to the major adverse cardiac events (MACE) of women with ACS in the coronary care unit, cardiovascular unit, and medical intensive care unit of a tertiary hospital from January 2015 to December 2020.

Methods

A descriptive retrospective cross-sectional research wherein data from 112 charts were collected and analyzed after approval from the research ethics committee.

Results

Among the patients, 95.41% are menopause and 78.57% are hypertensive. Chest pain (44.64%) and shortness/difficulty of breathing (53.57%) are the most frequently occurring symptoms with significant p-values of 0.044 and 0.010, respectively. Most patients with unstable angina (UA) (66.67%) and 72.6% of those with non-ST elevation myocardial infarction (NSTEMI) consulted beyond 6 hours after onset of symptoms. The usual site of infarction/ischemia are the anteroseptal and inferior walls, with significant p-values of 0.006 and 0.015, respectively, most frequently occurring in ST elevation myocardial infarction (STEMI) (27.59%). Ejection fractions of less than 40% were seen in 67% of ACS patients; 59% had wall motion abnormalities, 56.7% had aortic sclerosis, 82.47% had mitral regurgitation, 37% had concentric and 26.8% had eccentric left ventricular hypertrophy. Diastolic dysfunction was seen in 80.77% of STEMI patients with a significant P-value of 0.037. Three-vessel CAD was diagnosed in 47.83% of NSTEMI and 52.63% of STEMI patients, with the left anterior descending artery as the culprit lesion in 47.83% and 57.89%, respectively. One or more MACE were documented in 83.93%; 60% had heart failure and 58.93% had prolonged hospital stay.

Conclusion

The odds of having MACE increased by 5.97% for every year increase in patient’s age. ACS patients with initially elevated troponin I/high sensitivity troponin I, aortic sclerosis, and those who were given diuretics were 5.4, 4.08, and 34.4 times more likely to have MACE, respectively. NSTEMI patients with wall motion abnormalities, obstructive coronary angiograms, and those given diuretics were 13.7, 18, and 19.4 times most likely to experience MACE, respectively. The results emphasize the need to educate Filipino women and the importance of having regular check-ups, maintaining healthy lifestyle, recognizing symptoms, and seeking early consult. These will lead to prompt diagnosis and management of ACS, and eventually, to a decline in ACS-related morbidity and mortality.