Drug Treatments and Outcomes of Acute Coronary Syndrome Patients in Secondary-Care Hospital

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Pisacha Kasemsup
Suratchada Kongsri
Areewan Cheawchanwattana
Chulaporn Limwattananon

Abstract

Introduction: This study aimed to determine the prescribing rates for recommended drugs in early management, at discharge, and during ninety days of follow up in patients with acute coronary syndrome (ACS) in a secondary-care hospital. The survival rates and their risk factors were also investigated. Methods: This study was a retrospective medical chart review of ACS patients who were admitted in the hospital during the fscal year of 2008. Results: Two hundred and three patients were studied and classifed to be ST elevation myocardial infarction (STEMI) 27%, non-ST elevation myocardial infarction (NSTEMI) 41% and unstable angina (UA) 32%. In early management, 26% of STEMI patients received streptokinase while 56% and 35% of NSTEMI and UA patients received enoxaparin. Door-to-needle time of streptokinase was 13.87 ± 6.24 minutes. About 12% and 1% of patients were referred to tertiary-care hospitals for receiving coronary angiography (CAG) and percutaneous coronary intervention (PCI) respectively. The prescription rates of secondary prevention drugs at discharge and during ninety days of follow up were higher than 80% and 40% for anti-platelet drugs and statins respectively. However the prescribing rates of beta-blockers and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) were lower than 40%. The prescription rates of secondary prevention drugs were highest in STEMI patients. The 1-year survival rates of STEMI, NSTEMI and UA were 73%, 71% and 67%, respectively. The independent risk factor was serum creatinine level of equal to or greater than 1.5 mg/dL (HR=2.42, 95%CI 1.26-4.65). Conclusion: This study revealed the useful information about treatments in acute coronary syndrome patients, and these will lead to the improvement in the quality of care in these patients.

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