PMID- 26497226 OWN - NLM STAT- MEDLINE DCOM- 20160513 LR - 20181113 IS - 1471-2261 (Electronic) IS - 1471-2261 (Linking) VI - 15 DP - 2015 Oct 24 TI - Management of acute coronary syndromes in a developing country; time for a paradigm shift? an observational study. PG - 133 LID - 10.1186/s12872-015-0125-y [doi] LID - 133 AB - BACKGROUND: There are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. We aimed to identify the critical issues that limit optimal management of ACS in Sri Lanka. METHODS: We performed a prospectively observational study of 256 consecutive patients who presented with ACS between November 2011 and May 2012 at a tertiary care general medical unit in Sri Lanka. RESULTS: We evaluated data on presentation, management, in-hospital mortality, and major adverse cardiovascular events (MACE) of participants. Smoking, alcohol abuse, and obesity were more common in patients with ST elevation myocardial infarction (STEMI) (P < 0.05). Discharge diagnoses were STEMI in 32.8 % (84/256) and unstable angina (UA)/non-ST elevation myocardial infarction [NSTEMI] in 67.1 % (172/256) of participants. The median time (IQR) from onset of pain to presentation was 60 (319) minutes for STEMI and 120 (420) for UA/NSTEMI (P = 0.058). A median delay of 240 min was noted in patients who had presented initially to smaller hospitals. Cardiac markers were assessed in only 35 % of participants. In-hospital anti-platelet use was high (>92 %). Only 70.2 % of STEMI patients received fibrinolytic therapy. Fewer than 20 % of patients were received fibrinolytic therapy within 30 min of arrival. Major adverse cardiac events (MACE) were recorded in 11.9 % of subjects with STEMI and 11.6 % of those with UA/NSTEMI (P = 0.5). According to logistic regression analysis, body mass index (P = 0.045) and duration of diabetes (P = 0.03) were significant predictors of in-hospital MACE. On discharge, aspirin, thienopyridine, and statins were prescribed to more than 90 % of patients. Only one patient underwent coronary angiography during the index admission. CONCLUSIONS: Delays in presentation and in initiation of thrombolytic therapy and coronary interventions are key hurdles that need attention to optimize ACS care in Sri Lanka. FAU - Medagama, Arjuna AU - Medagama A AD - Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka. arjuna.medagama@gmail.com. FAU - Bandara, Ruwanthi AU - Bandara R AD - Professorial Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka. ruwanthibandara@yahoo.com. FAU - De Silva, Chinthani AU - De Silva C AD - Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka. chinthanids@gmail.com. FAU - Galgomuwa, Manoj Prasanna AU - Galgomuwa MP AD - Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka. manojgalgomuwa@gmail.com. LA - eng PT - Journal Article PT - Observational Study DEP - 20151024 PL - England TA - BMC Cardiovasc Disord JT - BMC cardiovascular disorders JID - 100968539 RN - 0 (Fibrinolytic Agents) RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Thienopyridines) RN - R16CO5Y76E (Aspirin) SB - IM MH - Acute Coronary Syndrome/*diagnosis/mortality/*therapy MH - Aged MH - Alcoholism/complications MH - Angina, Unstable/diagnosis/mortality/therapy MH - Aspirin/therapeutic use MH - Delayed Diagnosis MH - *Developing Countries MH - Female MH - Fibrinolytic Agents/therapeutic use MH - Hospital Mortality MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use MH - Male MH - Middle Aged MH - Myocardial Infarction/diagnosis/mortality/therapy MH - Obesity/complications MH - Percutaneous Coronary Intervention MH - Prospective Studies MH - Risk Factors MH - Smoking/adverse effects MH - Sri Lanka/epidemiology MH - Thienopyridines/therapeutic use MH - Thrombolytic Therapy PMC - PMC4619422 EDAT- 2015/10/27 06:00 MHDA- 2016/05/14 06:00 PMCR- 2015/10/24 CRDT- 2015/10/27 06:00 PHST- 2015/07/23 00:00 [received] PHST- 2015/10/16 00:00 [accepted] PHST- 2015/10/27 06:00 [entrez] PHST- 2015/10/27 06:00 [pubmed] PHST- 2016/05/14 06:00 [medline] PHST- 2015/10/24 00:00 [pmc-release] AID - 10.1186/s12872-015-0125-y [pii] AID - 125 [pii] AID - 10.1186/s12872-015-0125-y [doi] PST - epublish SO - BMC Cardiovasc Disord. 2015 Oct 24;15:133. doi: 10.1186/s12872-015-0125-y.