Mortality rates in CAD unacceptably high in poor Southeast Asian setting
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.