Impact of Delayed Presentation in the Treatment outcomes and it's Complications in patients with Acute Coronary Syndrome

ABSTRACT

Acute coronary syndrome describes a range of conditions associated with sudden, reduced blood flow to the heart & includes unstable angina, Non–ST-segment elevation myocardial infarction (NSTEMI) & ST-segment elevation myocardial infarction (STEMI). India has the highest burden of ACS in the world. Myocardial infarction accounts for more than 70% Patients experiencing STEMI have a greater short-term risk of complications, including death, compared to patients experiencing NSTEMI, whereas NSTEMI is associated with a greater long-term risk. To complete coronary occlusion, STEMI, the goal is for immediate revascularization to salvage myocardium. For NSTEMI and unstable angina (UA), treatment is to mitigate the changes of recurrent infarction and/or to reduce the size of infarction. To assess the factors associated with the impact of delayed presentation in the treatment outcomes and its complications in patients with acute coronary syndrome. This is a prospective observational study which was carried out in Narasaraopeta over a period of 6 months i.e. / /2022 to / /2023.About 120 study participants were analyzed for time of presentation to the hospital based on time of onset of symptoms, past medical history, risk factors, diagnosis, age, gender, social history. A sample size of 120 subjects was included. A total of 120 subjects were included with different types of ACS during the study period.49 (40.83%) subjects with STEMI 40 (33.34%) subjects with Unstable Angina & 31 (25.83%) subjects with NSTEMI were found. Patients included in this study majorly presented delay to the hospital after symptoms occur 94 (78.34%) than who presented early to the hospital 26 (21.66%). The epidemiological results of this study revealed that people with age group between 41-70 yrs were more affected and males 79 (65.83%) were highly affected when compared to females 41 (34.16%). Treatment outcomes in ACS were observed that there is longer treatment duration of anticoagulant therapy for delayed presentation than early presentation. It was identified that main factors for delaying were pre-hospital factors like unaware of condition. patients may feel that it is a gastric problem and delays till chest pain become worse. Within a short study period we observed that pulmonary edema, decreased EF (ejection fraction) and dyspnea were common complications were observed in delayed presented patients. So, improvement in patients QOL is achieved by creating awareness among them and educates them regarding the disease, medications, life style modifications and cost effective treatment.

Keywords: Acute coronary syndrome, delayed presentation, anticoagulant therapy, early presentation.