NCVD-ACS REGISTRY.

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Presentation transcript:

NCVD-ACS REGISTRY

NCVD-ACS Registry: Annual Report 2006 Published by: Clinical Research Centre, Ministry of Health Malaysia Suggested citation: W.A. Wan Ahmad. K.H. Sim (Eds.). Annual Report of the NCVD-ACS Registry 2006. Kuala Lumpur. 2008 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Chapter 1: Provision of Acute Coronary Care Services in Malaysia Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

In 2006, there are 73 coronary care units (CCU) in Malaysia The incidence of ACS admission was therefore 47.1 per 100,000 population in 2006 The estimate of the incidence of coronary heart disease (CHD) in Malaysia is 141 per 100,000 population Over 4000 ACS being denied admission into its CCU in 2006. It has 30% shortfall in CCU beds Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Acute Coronary/ Cardiac Care Services and Admissions in Malaysia 2006 CCU Cardiologist nurses Cath. Lab Cardiac surgical service ACS admission N(%) Malaysia 73(100) 163(100) 559(100) 36(100) 27(100) 12,534(100) By Sector Private 32(44) 81(50) 176(31) 28(78) 20(74) 3,398(27) MOH 37(51) 37(23) 305(55) 4(11) 4(15) 7,580(60) IJN 1(1) 27(17) 13(2) 1(3) 1(4) 335(3) University 3(4) 17(10) 65(12) 3(8) 2(7) 1,221(10) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Utilization of Acute Coronary / Cardiac Services in Malaysia 2006 Current CCU beds Bed occupancy rate Use for all acute ACS non cardiac ACS denied *RBS if non cardiac excluded N(%) % % of all ACS (% shortfall) Malaysia 414(100) 89 65 40 35 Sectors Private 214(52) 83 51 27 49 48 132 MOH 169(41) 93 77 23 62 IJN 12(3) 36 26 64 53 171 University 19(5) 104 76 58 24 14 119 *RBS – Required bed strength Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Utilization of Acute Coronary / Cardiac Services by Sectors in Malaysia 2006 *RBS – Required bed strength Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac Care provided for ACS in Malaysia 2006 ACS admits Thrombolytic Angiogram PCI CABG % Malaysia 100 38 33 20 7 Sector Private 27 25 64 43 16 MOH 60 44 19 11 3 IJN 59 77 40 12 University 10 30 2 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Distribution of Cardiologist per million populations (pmp) by state Relationship between availability of cardiologist and provision of emergency Coronary angiogram and Percutaneous Coronary Intervention (PCI) for patients admitted with ACS in Malaysia 2006 50 100 150 200 250 PCI pmp 300 400 Coronary Angiogram pmp 2 4 6 8 10 12 14 16 18 20 Cardiologist pmp Distribution of Cardiologist per million populations (pmp) by state Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Sample Size = 3422 patients registered in year 2006

NCVD-ACS Registry Participating Sites in 2006 SBH TFH RPZ II H PH TAAH *NHI *UMMC *KLH TFH Tuanku Fauziah Hospital SBH Sultanah Bahiyah Hospital PH Penang Hospital NHI National Heart Institute UMMC University Malaya Medical Centre KLH Kuala Lumpur Hospital TJH Tuanku Ja’afar Hospital SAH Sultanah Aminah Hospital RPZ II H Raja Perempuan Zainab II Hospital TAAH Tengku Ampuan Afzan Hospital SGH Sarawak General Hospital SGH TJH SAH Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Chapter 2: Patient Characteristics

Age Group for patient with ACS, Malaysia 2006 Age group, no. % (N = 3422) 20 - <30 23 (1) 30 - <40 143 (4) 40 - <50 621 (18) 50 - <60 1054 (31) 60 - <70 881 (26) 70 - <80 571 (17) 80 129 (4)

Age Group for patient with ACS, Malaysia 2006 % of patients Age Group Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Gender distribution for patients with ACS, Malaysia 2006 Gender, no. % (N=3422) Male 2569(75) Female 853 (25) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Ethnic group distribution for patients with ACS, Malaysia 2006 Ethnic group, no. % (N= 3422) Malay 1684 (49) Chinese 786 (23) Indian 799 (23) Orang Asli 0 (0) Kadazan 2 (0) Melanau Murut Bajau 1 (0) Bidayuh 28 (1) Iban 48 (1) Other Malaysian 37 (1) Foreigner Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Ethnic group distribution for patients with ACS, Malaysia 2006 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Other Coronary Risk Factors for patients with ACS, Malaysia 2006 Other Coronary Risk Factors (N=4332) % Smoking 40 Family history of premature cardiovascular disease 12 BMI > 23kgm-2 Mean, SD 75 25.8 (4.4) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Other Coronary Risk Factors for patients with ACS, Malaysia 2006 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Co-morbidities of patients with ACS, Malaysia 2006 Co-morbidities (N=3422) % Dyslipidaemia 33 Hypertension 61 Diabetes 44 Myocardial infarction history 16 Documented CAD > 50% stenosis 15 Chronic angina (onset>2 weeks ago) New onset angina <2 weeks) 45 Coronary artery disease* 64 *Coronary artery disease is defined as “Yes” on any of the following co-morbidities: 1) History of myocardial infarction, 2) Documented CAD >50% stenosis, 3) Chronic angina (onset more than 2 weeks ago), 4) New onset angina (less than 2 weeks). Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Age-gender distribution for patients with ACS, Malaysia 2006 Age group Male Female 20 - <30 1 30 - <40 5 40 - <50 21 9 50 - <60 35 19 60 - <70 24 31 70 - <80 12 80 3 8 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Chapter 3: Clinical Presentation and Investigation Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac Presentations of Patients with ACS by ACS Stratum, Malaysia 2006 STEMI NSTEMI UA N=1445 N=1132 N=845 Systolic blood pressure, mmHg N 1428 1116 836 Mean, SD 134 (28) 145 (30) 146 (28) Median, (min, max) 130 (60, 230) 142 (66, 230) 142 (60, 224) Diastolic blood pressure, mmHg 1402 1087 823 80 (17) 82 (17) 82 (15) 80 (26, 120) 82 (19, 120) 82 (34, 120) Heart rate at presentation, beats/min 1434 1122 838 82 (21) 86 (23) 81 (19) 80 (30, 180) 84 (29, 180) 79 (40, 166) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac Presentations of Patients with ACS by ACS Stratum, Malaysia 2006 Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac Biomarkers Done for Patients with ACS by ACS Stratum, Malaysia 2006 STEMI (N=1445) NSTEMI (N=1132) Patients with any cardiac marker done, no. % 1402 (97) 1114 (98) Peak CK-MB, Unit/L, no. % 801 874 >25 681 (85) 457 (52) Peak CK, Unit/L, no. % 1325 970 >2x reference upper limits 999 (75) 364 (38) Peak TnT, no. % 183 446 Positive or >0.01 181 (99) 436 (98) Peak TnI, no. % 58 167 Positive or > reference upper limit/0.04 54 (93) 156 (93) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

* The denominators are based on STEMI, N=1445 and NSTEMI, N= 1132. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

ACS Stratum for Patients with ACS by Age Group, Malaysia 2006 Acute coronary syndrome stratum, no. % Age group* Young Middle-age Elderly N=166 N=1675 N=1581 STEMI 113 (68) 803 (48) 529 (33) NSTEMI 28 (17) 469 (28) 635 (40) UA 25 (15) 403 (24) 417 (26) *Young is defined as age from 20 to less than 40 years, middle-age is defined as age between 40 to less than 60 years and elderly is defined as 60 years and above Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac presentation of patients with ACS by gender, Malaysia 2006 Acute Coronary Syndrome Stratum, No. (%) Male Female N=2569 N=853 STEMI 1230 (48) 215 (25) NSTEMI 779 (30) 353 (41) UA 560 (22) 285 (33) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Chapter 4: Treatment Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Summary of treatments for patients with ACS by ACS stratum, Malaysia 2006 No. (%) STEMI NSTEMI UA N=1445 N=1132 N=845 Total admission days* N 1420 1104 830 Mean, SD 6 (3) 6 (4) 5 (4) Median, (min, max) 5 (1,28) 5 (1,30) 4 (1,29) Number of days on CCU 1093 450 140 3 (3) 4 (3) 3 (1,26) 3 (1,24) 2 (1,20) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Fibrinolytic Therapy for ACS Patients with STEMI, Malaysia 2006 Fibrinolytic therapy for STEMI (N=1445) No . (%) Given 1018 (70) Not given 427 (30) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Reasons Fibrinolytic Therapy Not Given to Patients with STEMI, Malaysia 2006 Reasons Fibrinolytic Therapy Not Given to ACS Patients (N=1445) No. (%) Proceeded directly to primary angioplasty 117 (8) Contraindicated 70 (5) Missed thrombolysis 193 (13) Others* 47 (3) *Not given–Others includes missing and refusal Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

*Not given–Others includes missing and refusal Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Cardiac Catheterization for Patients with ACS by ACS Stratum, Malaysia 2006 no. % STEMI (N=1445) NSTEMI (N=1132) UA (N=845) Yes 298 (21) 251 (22) 106 (13) No 1106 (77) 858 (76) 727 (86) Transferred to another centre 39 (3) 23 (2) 12 (1) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Percutaneous coronary intervention, no. % Percutaneous Coronary Intervention, for Patients with ACS by ACS Stratum, Malaysia 2006 Percutaneous coronary intervention, no. % STEMI (N=1445) NSTEMI (N=1132) UA (N=845) Yes 308 (21) 162 (14) 80 (9) No 1137 (79) 970 (86) 765 (91) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

CABG for Patients with ACS by ACS Stratum, Malaysia 2006 CABG, no. % STEMI (N=1445) NSTEMI (N=1132) UA (N=845) Yes 10 (1) 42 (4) 15 (2) No 1435 (99) 1090 (96) 830 (98) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Chapter 5: Outcomes Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall Outcomes for Patients with ACS, Malaysia 2006 Overall outcome Outcome In-hospital 30-day* No. % Discharged / Alive 3186 93 2302 67 Died 229 7 288 8 Lost to follow-up NA 832 24 Missing *Including patients who died in-hospital Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall outcomes for patients with ACS by ACS stratum, Malaysia 2006 In-hospital 30-day* STEMI NSTEMI UA No. % Discharged /Alive 1312 91 1056 93 818 97 939 65 796 70 567 67 Died 129 9 75 7 25 3 158 11 92 8 38 4 Lost to follow-up NA 348 24 244 22 240 28 Missing 1 2 *Including patients who died in-hospital. Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall outcomes for patients with STEMI by fibrinolytic therapy, Malaysia 2006 In-hospital 30-day* Fibrinolytic therapy Yes No No. % Discharged / Alive 940 92 372 87 686 67 253 59 Died 74 7 55 13 90 9 68 16 Lost to follow-up NA 242 24 106 25 Missing 4 *Including patients who died in-hospital. Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall outcomes for patients with STEMI by Percutaneous Coronary Intervention, Malaysia 2006 Outcome In-hospital 30-day* Percutaneous coronary intervention Yes No No. % Discharged / Alive 283 92 1029 91 242 79 697 61 Died 25 8 104 9 34 11 124 Lost to follow-up NA 32 10 316 28 Missing 4 *Including patients who died in-hospital. Notes: 1. Percentage is to the nearest decimal point. 2. Percutaneous Coronary Intervention includes primary, rescue and facilitated intervention Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

CABG for Patients with ACS by ACS Stratum, Malaysia 2006 CABG, no. % STEMI (N=1445) NSTEMI (N=1132) UA (N=845) Yes 10 (1) 42 (4) 15 (2) No 1435 (99) 1090 (96) 830 (98) Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Pre-admission aspirin use Overall outcomes for patients with STEMI by pre-admission aspirin use, Malaysia 2006 Outcome In-hospital 30-day* Pre-admission aspirin use Yes No Unknown No. % Discharged / Alive 200 88 885 92 227 90 128 56 660 68 151 60 Died 27 12 76 8 26 10 33 15 95 30 Lost to follow-up NA 66 29 210 22 72 28 Missing 4 *Including patients who died in-hospital. Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall outcomes for patients with NSTEMI/UA by Percutaneous Coronary Intervention, Malaysia 2006 Outcome In-hospital 30-day* Percutaneous coronary intervention Yes No No. % Discharged / Alive 233 96 1641 95 207 86 1156 67 Died 9 4 91 5 12 118 7 Lost to follow-up NA 23 10 461 27 Missing 3 *Including patients who died in-hospital. Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Overall outcomes for patients with NSTEMI/UA by CABG, Malaysia 2006 In-hospital 30-day* CABG Yes No No. % Discharged / Alive 49 86 1825 95 47 82 1316 69 Died 8 14 92 5 122 6 Lost to follow-up NA 2 4 482 25 Missing 3 *Including patients who died in-hospital. Note: Percentage is to the nearest decimal point. Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006

The full report is available for download at www.acrm.org.my/ncvd Annual Report of the Acute Coronary Syndrome (ACS) Registry, Malaysia 2006