National Cardiovascular Disease Database (NCVD) NCVD Acute Coronary Syndrome (ACS) Registry An Update Dato’ Dr Azhari Rosman Chairman of NCVD ACS Registry Sentral Accord Room, Hilton Kuala Lumpur 19 th April 2009

National Cardiovascular Disease Database (NCVD) *SGH *HSAJB *PH HSJ *IJN *UMMC *HKL *HTAR ACS Registry Participating Sites *QEH * Active sites *HI HSNZ *HRPZ II*HTF *HSB *HTJ *HTAA *HM MMC (2009)

National Cardiovascular Disease Database (NCVD) 1. Report: NCVD-ACS Registry Annual report year 2006 Downloadable online at Current Activities

National Cardiovascular Disease Database (NCVD) 2. NCVD-ACS Registry Annual Report year 2007 Currently in the midst of data- cleaning stage Current Activities

National Cardiovascular Disease Database (NCVD) Current Updates as of 9 th April 2009 (based on unclean data)

National Cardiovascular Disease Database (NCVD) Acute Coronary Syndrome (ACS) Registry

National Cardiovascular Disease Database (NCVD) ACS cases registered online by Source Data Providers (SDP) Results as of 9 th April 2009, n= 10,864 Total SDP = 15 sites

National Cardiovascular Disease Database (NCVD) Patient’s Demographics Age Min, Max mean + sd 18.33, yrs yrs Male75.31 % Ethnic : Malay47.47 % Chinese22.96 % Indians23.25 % Other Malaysian3.88 % Foreigner1.33 % * Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli, Melanau, Murut, Bajau, Bidayuh ** For 121 cases, there are no information on ethnicity Baseline (n= 10,730) Baseline (n= 10,864)

National Cardiovascular Disease Database (NCVD) Smoking Status Never36.25 % Stopped (quit > 30 days)21.45 % Current (within last 30 days)32.03 % Not Available10.27 % Status of Aspirin use Used <7 days10.47 % Used >7 days22.06 % None51.96 % Unknown15.51 % Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) CV Risk Factors Dyslipidaemia32.42 % Hypertension57.69 % Diabetes40.56 % Family History of premature CVD11.16 % MI history16.68 % Documented CAD16.21 % New onset angina (< 2 weeks)48.08% Chronic angina (onset > 2 weeks ago)11.29% Chronic Lung Disease3.26 % Renal disease6.40 % Peripheral vascular disease0.75 % Cerebrovascular disease3.42 % Heart Failure6.46 % Results as of 9 th April 2009, n= 10,864

Institut Jantung Negara National Heart Institute Risk Factors: Malaysian NCVD-PCI Registry(IJN) 51% 72% 82%

National Cardiovascular Disease Database (NCVD) No episode14.42 % % % % % % % % Number of distinct angina episode within 24hrs % % % % % % NA37.48 % Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Heart Rate83.5 beats/min Systolic BP mmHg Diastolic BP81.12 mmHg Clinical Examination Killip classification I46.27 % II16.37 % III3.94 % IV3.31 % Not stated/inadequately described12.73 % Not available17.38 % Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) ECG abnormalities type ST-segment elevation ≥ 1mm (0.1mV) in ≥ 2 contiguous limb leads % ST-segment elevation ≥ 2mm (0.2mV) in ≥ 2 contiguous frontal leads or chest leads % ST-segment depression ≥ 0.5mm (0.05mV) in ≥ 2 contiguous leads % T-wave inversion ≥ 1mm (0.1mV) % Bundle branch block (BBB) 4.95 % Non-specific 5.23 % None 6.01 % Not stated / inadequately described 1.86 % Baseline (n= 10,864) Results as of 9 th April 2009

National Cardiovascular Disease Database (NCVD) ECG abnormalities location Inferior leads : II, III, aVF31.42 % Anterior leads : V1 to V % Lateral leads : I, aVL, V5 to V % True posterior : V1 V24.58 % Right ventricle : ST elevation in lead V4R3.77 % None9.86 % Not stated / inadequately described3.89 % Baseline (n= 10,864) Results as of 9 th April 2009

National Cardiovascular Disease Database (NCVD) Percentage of Ischaemic status by ACS stratum (n=10,864) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Percentage according to TIMI Risk Score for STEMI (n= 4,705) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Percentage according to TIMI Risk Score for NSTEMI/UA (n=5,427) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Given at this centre % Given at another centre prior to transfer % Not given - proceeded directly to primary angioplasty 7.25 % Not given - Missed Thrombolysis % Not given - patient refusal 0.17 % Not given - Contraindicated 4.21 % Not Applicable 2.67 % Fibrinolytic Therapy Status Baseline (n= 4,705) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Fibrinolytic Drug Used (n=2,861) Streptokinase91.68 % Others2.31 % Missing6.01 % Door to needle time (mins) Cardiac Cathetherization Yes19.00 % No60.73 % No - transferred to another centre2.31 % Missing17.95 % Baseline (n= 10,864) Results as of 9 th April 2009

National Cardiovascular Disease Database (NCVD) PCI on this admission Yes (n=1,588)14.62 % Yes – for STEMI42.1 % No55.56 % Not Applicable12.08 % Missing17.75 % Door to balloon time (mins) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Pharmacological Therapy Drug used/given during admission (%) Drug Pre- admission During After discharge ASA ADP Antagonist GP Receptor inhibitor Unfrac Heparin LMWH Beta Blocker ACE Inhibitor Angiotensin II receptor blocker Statin Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Drug used/given during admission (%) Drug Pre- admission During After discharge Other Lipid Lowering Agent Diuretics Calcium Antagonist Oral Hypoglycaemic Agent Insulin Anti-arrhythmic Agent Results as of 9 th April 2009, n= 10,864 Pharmacological Therapy

National Cardiovascular Disease Database (NCVD) In-hospital Clinical Outcome Outcome (%) Discharged85.65 Transferred1.98 Died6.91 NA5.55 Cause of Death (%) CVD74.57 Non-CVD4.39 Other2.26 Missing18.77 Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) In-hospital Clinical Outcome Final Diagnosis at Discharge (%) Q Wave MI35.76 Non-Q Wave MI19.89 Unstable Angina24.96 Stable Angina1.20 Non-cardiac1.45 Missing Bleeding Complication (TIMI Criteria) (%) Major0.49 Minor1.58 Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Follow up at 30days & 1year

National Cardiovascular Disease Database (NCVD) Overall Follow Up Management Type of FU30days FU1year FU TotalN%N% Expected visits FU Done Missed FU Results as of 9 th April 2009

National Cardiovascular Disease Database (NCVD) Overall Follow Up done at 30days & 1year

National Cardiovascular Disease Database (NCVD) Follow Up done at 30days & 1year by SDP Percentage of FU done (%) SDP Total 30days FU = 6,493 (as of 9 th April 2009) Total 1year FU = 3,352 (as of 9 th April 2009)

National Cardiovascular Disease Database (NCVD) Cardiovascular readmission ACS STEMI NSTEMI UA Missing 3.89 % % % % % Heart Failure0.49 % Revascularization5.15 % PCI87.54 % CABG9.79 % Stroke0.11 % 2.07 % % 7.14 % % % 0.53% 3.11% % % 0.06 % 30days (n= 6,550)1year (n= 3,374) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Outcome at 30 days & 12 months % 3.45 % 8.98 % 0.58 % 1.6 % Outcome Alive Death Lost to FU Transferred Missing % 2.31 % % 0.18 % 2.4 % Cause of Death CVD Non CVD Others Missing % 8.97 % % % 1year (n= 3,374) 1year (n= 78) 30days (n= 6,550) % % % % 30days (n= 226) Results as of 9 th April 2009, n= 10,864

National Cardiovascular Disease Database (NCVD) Thank you