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

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

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

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

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

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

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

8. Patient’s Demographics
Baseline (n= 10,730)
Age
Min, Max
mean + sd
18.33, yrs
yrs
Male
75.31 %
Baseline (n= 10,864)
Ethnic : Malay
47.47 %
Chinese
22.96 %
Indians
23.25 %
Other Malaysian
3.88 %
Foreigner
1.33 %
* Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli,
Melanau, Murut, Bajau, Bidayuh
** For 121 cases, there are no information on ethnicity
National Cardiovascular Disease Database (NCVD)

9. Smoking Status Status of Aspirin use
Never
36.25 %
Stopped (quit > 30 days)
21.45 %
Current (within last 30 days)
32.03 %
Not Available
10.27 %
Status of Aspirin use
Used <7 days
10.47 %
Used >7 days
22.06 %
None
51.96 %
Unknown
15.51 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

10. CV Risk Factors Results as of 9th April 2009, n= 10,864 Dyslipidaemia
32.42 %
Hypertension
57.69 %
Diabetes
40.56 %
Family History of premature CVD
11.16 %
MI history
16.68 %
Documented CAD
16.21 %
New onset angina (< 2 weeks)
48.08%
Chronic angina (onset > 2 weeks ago)
11.29%
Chronic Lung Disease
3.26 %
Renal disease
6.40 %
Peripheral vascular disease
0.75 %
Cerebrovascular disease
3.42 %
Heart Failure
6.46 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

11. Risk Factors: Malaysian NCVD-PCI Registry(IJN)
51%
82%
Why IHD has many ED- due to incd comobiditiues
72%

12. Number of distinct angina episode within 24hrs
No episode
14.42 % 1
36.38 % 2
7.52 % 3
2.73 % 4
0.71 % 5
0.38 % 6
0.14 % 7
0.06 % 8
0.02 % 9 10
0.07 % 11 12
0.01 % 14
0.03 % 20 NA
37.48 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

13. Not stated/inadequately described
Clinical Examination
Heart Rate
83.5 beats/min
Systolic BP
mmHg
Diastolic BP
81.12 mmHg
Killip classification I
46.27 % II
16.37 %
III
3.94 % IV
3.31 %
Not stated/inadequately described
12.73 %
Not available
17.38 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

14. ECG abnormalities type
Baseline (n= 10,864)
ST-segment elevation ≥ 1mm (0.1mV) in
≥ 2 contiguous limb leads
17.31 %
ST-segment elevation ≥ 2mm (0.2mV) in
≥ 2 contiguous frontal leads or chest leads
31.16 %
ST-segment depression ≥ 0.5mm (0.05mV) in ≥ 2 contiguous leads
24.57 %
T-wave inversion ≥ 1mm (0.1mV)
20.54 %
Bundle branch block (BBB)
4.95 %
Non-specific
5.23 %
None
6.01 %
Not stated / inadequately described
1.86 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)

15. ECG abnormalities location
Baseline (n= 10,864)
Inferior leads : II, III, aVF
31.42 %
Anterior leads : V1 to V4
41.96 %
Lateral leads : I, aVL, V5 to V6
30.23 %
True posterior : V1 V2
4.58 %
Right ventricle : ST elevation in lead V4R
3.77 %
None
9.86 %
Not stated / inadequately described
3.89 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)

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

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

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

19. Fibrinolytic Therapy Status
Baseline (n= 4,705)
Given at this centre
60.81 %
Given at another centre prior to transfer
12.41 %
Not given - proceeded directly to primary angioplasty
7.25 %
Not given - Missed Thrombolysis
12.48 %
Not given - patient refusal
0.17 %
Not given - Contraindicated
4.21 %
Not Applicable
2.67 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

20. Fibrinolytic Drug Used (n=2,861)
Streptokinase
91.68 %
Others
2.31 %
Missing
6.01 %
Door to needle time (mins)
Baseline (n= 10,864)
Cardiac Cathetherization
Yes
19.00 % No
60.73 %
No - transferred to another centre
2.31 %
Missing
17.95 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)

21. Door to balloon time (mins) 233.77 + 292.63
PCI on this admission
Yes (n=1,588)
14.62 %
Yes – for STEMI
42.1 % No
55.56 %
Not Applicable
12.08 %
Missing
17.75 %
Door to balloon time (mins)
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

22. Pharmacological Therapy
Drug used/given during admission (%)
Drug
Pre-admission
During
After discharge
ASA
52.26
85.98
69.78
ADP Antagonist
20.50
60.53
47.08
GP Receptor inhibitor
0.52
2.90
Unfrac Heparin
1.29
11.36
LMWH
9.75
50.64
Beta Blocker
24.51
61.73
52.40
ACE Inhibitor
18.87
53.57
45.08
Angiotensin II receptor blocker
4.60
7.35
6.32
Statin
30.03
83.97
69.31
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

23. Pharmacological Therapy Drug used/given during admission (%)
Pre-admission
During
After discharge
Other Lipid Lowering Agent
2.34
5.40
4.41
Diuretics
12.56
28.68
17.04
Calcium Antagonist
9.89
14.28
11.17
Oral Hypoglycaemic Agent
19.40
24.98
25.03
Insulin
6.93
23.38
8.17
Anti-arrhythmic Agent
2.22
6.66
3.55
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

24. In-hospital Clinical Outcome
Discharged
85.65
Transferred
1.98
Died
6.91 NA
5.55
Cause of Death (%)
CVD
74.57
Non-CVD
4.39
Other
2.26
Missing
18.77
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

25. In-hospital Clinical Outcome
Final Diagnosis at Discharge (%)
Q Wave MI
35.76
Non-Q Wave MI
19.89
Unstable Angina
24.96
Stable Angina
1.20
Non-cardiac
1.45
Missing
16.74
Bleeding Complication (TIMI Criteria) (%)
Major
0.49
Minor
1.58
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

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

27. Overall Follow Up Management
Type of FU
30days FU
1year FU
Total N %
Expected visits
9650
7604
FU Done
6493
67.28
3352
44.08
Missed FU
3157
32.72
4252
55.92
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)

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

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

30. Cardiovascular readmission
30days (n= 6,550)
1year (n= 3,374)
ACS
STEMI
NSTEMI UA
Missing
3.89 %
14.51 %
14.90 %
53.73 %
16.86 %
Heart Failure
0.49 %
Revascularization
5.15 %
PCI
87.54 %
CABG
9.79 %
Stroke
0.11 %
2.07 %
12.86 %
7.14 %
61.43 %
11.43 %
0.53%
3.11%
78.09 %
15.24 %
0.06 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

31. Outcome at 30 days & 12 months
Alive
Death
Lost to FU
Transferred
Missing
85.39 %
3.45 %
8.98 %
0.58 %
1.6 %
30days (n= 6,550)
84.53 %
2.31 %
10.58 %
0.18 %
2.4 %
1year (n= 3,374)
Cause of Death
CVD
Non CVD
Others
Missing
55.31 %
10.62 %
13.27 %
20.80 %
30days (n= 226)
47.44 %
8.97 %
21.79 %
21.80 %
1year (n= 78)
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)

32. Thank you
National Cardiovascular Disease Database (NCVD)