Outcomes in ST elevation myocardial infarction; a comparison of a tertiary care center in Pakistan with European centers

Objectives: To evaluate the clinical characteristics and in hospital outcome data of patients presenting to the Aga Khan University Hospital with ST elevation Myocardial Infarction (STEMI) and its comparison with data from patients enrolled in the European Heart registry for the same duration. Methods: Data on 296 patients with STEMI was prospectively collected from 1st January 2010, till 31st December 2010 from the cardiology section at the Aga Khan University Hospital. European data was collected on 7485 patients retrieved from the Eurobservational Research programme Acute Coronary Syndrome Registry 2010 for the same duration. Results: A total of 296 patients were enrolled from AKUH and 7485 from European centers for the year 2010. Majority of patients in both groups were male. Pakistani patients were more likely to be younger and diabetic (p<0.05) with higher frequency of prior myocardial infarction and angina (p<0.05). They were less likely to be smokers and previously diagnosed as dyslipidemic. Most patients presented to hospital with chest pain, median time between symptom onset and hospital arrival was 3.8 (2.0-8.5) hours. One third of European patients received a thrombolytic agent compared with less than 5% of AKU/Pakistani patients. Almost 90% of AKU/Pakistani patients underwent primary percutaneous intervention. Approximately 5.8% of our patients were not candidates for any reperfusion therapy vs. 4.8% of European patients. On coronary angiogram, the majority of patients had single or two vessel Coronary Artery Disease. We had a higher frequency of high risk lesions, 97.86 vs. 84.14%(p=0.002).Our patients had more drug eluting stents 42.5% vs. 25.9%(p=0.01) implanted, due to more diabetics and smaller vessel size. We also had a similar proportion of patients undergoing coronary artery bypass graft. Frequency of complications was similar for both cohorts. Median hospital stay in our patients was shorter, survival at hospital discharge being similar between both groups (P=0.42) Conclusions: The patients presenting to Aga Khan University Hospital with STEMI were younger and more likely to be diabetic. They had a higher frequency of prior Myocardial Infarction and angina. They underwent revascularization with primary percutaneous intervention more often and usually for more complex lesions requiring greater use of drug eluting stents. Survival at discharge was similar compared to European Centers.