A Study on Clinical Profile, Risk Factors, Angiographic findings and in hospital outcomes in patient with Acute Myocardial Infraction presented in Tertiary Care Cardiac Centre of Nepal

Abstract

Introduction: Cardiovascular diseases are the commonest cause of death globally account for approximately 12 million deaths annually and are the major contributor to the burden of premature mortality and morbidity¹. Coronary Artery Disease (CAD) is becoming a major cause in the developing world as well. Asians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance2.

Methods: The study was carried out for the identification of clinical profiles, risk factors and to know the severity of coronary lesions in angiography in acute myocardial infarction. We enrolled 200 consecutive patients with clinical history and typical ischemic ECG changes admitted in Man Mohan cardiothoracic vascular and transplant center through emergency department from January 2016 to December 2017. A predefined Performa was completed to every patient with a detailed clinical history, physical examinations, and investigation studies. The clinical history revealed information about age, gender, risk factors, and modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented by 12 lead ECG

Results: The study showed a significant male predominance with mean age being 54.5 years. The commonest presenting symptom was chest pain (90%), followed by sweating (86%) and. Breathlessness (62%) Tobacco was identified as major risk factors (62%) followed by Hypertension (42%), Diabetes (38%) and strong family history of CAD (28%), Dyslipidemia (26%) & obesity (BMI >25) is least common risk factor (19%) in this study. Patients had typical chest pain (90%) and ECG showed anterior wall changes in 51%. Angiography revealed Left anterior descending (LAD) was the most common culprit artery (41%) followed by Right Coronary Artery (RCA) in STEMI and Left Circumflex Artery (LCX) and multi vessel involvement in NSTEMI. Complications developed in 42.5% of patients, majority being different type of arrhythmias (56%) and least common is mechanical complications (3.5%). All the patients with mechanical complications died in the hospital.

Conclusion: Thus we conclude that AMI is more common in adult male, typical chest pain was the most common presenting symptoms with tobacco use being the major risk factors, anterior wall was the most common STEMI and LAD was the most common culprit artery, Multi vessel with LCX was the predominantly involved in NSTEMI in our study population.