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Mortality rates in CAD unacceptably high in poor Southeast Asian setting

14 Aug 2018

Patients with coronary artery disease (CAD) treated in a poor Southeast Asian setting appear to have far too high short-term and medium-term mortality rates, according to a study.

Researchers examined 477 patients with acute coronary syndrome and stable CAD admitted to Makassar Cardiac Center in Indonesia. They collected data on clinical outcomes and postdischarge status. The primary outcome was all-cause mortality.

A total of 154 patients (32.3 percent) died during a median follow-up of 18 months from hospital admission. Deaths in the hospital occurred with significantly greater frequency among patients with acute myocardial infarction than among those with unstable and stable angina (p=0.002).

Mortality rates differed among the following groups: non-ST-segment elevation myocardial infarction (n=41; 48.2 percent), ST-segment elevation myocardial infarction (n=65; 30.8 percent), unstable angina (n=18; 26.5 percent) and stable CAD (n=30; 26.5 percent; p=0.007).

Independent predictors of all-cause mortality were hyperglycaemia on admission (hazard ratio [HR], 1.55; 95 percent CI, 1.12–2.14; p=0.008), heart failure/Killip class ≥2 (HR, 2.50; 1.76–3.56; p<0.001), estimated glomerular filtration rate <60 mL/min (HR, 1.77; 1.26–2.50; p=0.001), no revascularization (percutaneous coronary intervention/coronary artery bypass grafting; HR, 2.38; 1.31–4.33; p=0.005) and poor adherence to postdischarge medications (HR, 10.28; 5.52–19.16; p<0.001).

Of note, poor medication adherence predicted postdischarge mortality, irrespective of underlying CAD diagnosis (p=0.88 for interaction).

According to researchers, the present data provide a general picture of risk stratification for clinical practitioners to recognize CAD patients with poor prognosis in a resource-limited Southeast Asian setting, particularly in Indonesia.

Survival in such a population may be improved with better access to early and late hospital care and patient education for better survival in CAD, researchers added. This can be done by optimizing medication adherence and lifestyle adjustment, irrespective of the underlying CAD diagnosis.

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Most Read Articles
20 Jun 2020
The Lundbeck Neuroscience Symposium was held at Sofitel KL Damansara over 2 days, with extensivediscussions on the management of various mental illnesses. The second day of the symposiumaddressed the topic of schizophrenia management, focusing on treatment goals, the rationale forpartial dopamine D(2) receptor agonism and the use of long-acting injectable (LAI) antipsychotics topromote adherence.
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Consumption of whole almonds as snacks not only reduces low-density lipoprotein cholesterol (LDL-C) but also significantly improves endothelial function in adults with above-average risk of cardiovascular disease (CVD), according to the results of a trial.
Pearl Toh, 2 days ago
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
27 May 2020
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