Mortality Rate and Its Associated Factors in Patients with Non ST-Elevation-Acute Coronary Syndrome in Bali: Results from A Single Center Registry

Abstract

Non-ST elevation – acute coronary syndrome (NSTE-ACS) consisted of non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) diagnoses, which are common cardiac events in Indonesia, including Bali. To evaluate in-hospital mortality and its associated factors in patients with NSTE-ACS patients in the Province of Bali. This was a cross-sectional study using data from ACS 2016 registry in Bali. Subjects were adult ACS patients who were hospitalized in Sanglah General Hospital (SGH), Denpasar, Bali Island. Diagnosis of ACS was grouped into NSTEMI and UAP. Demography, clinical data, and anticoagulant treatment were analyzed. Clinical outcome was in-hospital mortality. A total of 421 NSTE-ACS patients were diagnosed; 300 (71.3%) among them were men. Patients’ mean age was 59 + 12.0 years. Diagnoses were UAP in 260 (61.8%) and non-STEMI in 161 (38.2%) cases. Heparin treatment was given to 409 (97.1%) patients, consisted of 96 (22.8%) unfractionated heparin (UFH), 177 (42.0%) fondaparinux, and 136 (32.3%) enoxaparin. There were 8 (1.9%) patients who underwent early PCI. The overall mortality rate of NSTE-ACS patients was 6.4%; it was higher in NSTEMI than UAP patients (13.0% vs. 2.3%; p<0.001; OR = 6.350; 95% CI = 2.504 – 16.101). Components of GRACE risk score and a score of >140 were risk factor for in-hospital death. Mortality rate was 12.5% with heparin therapy, 6.6% in patients treated with enoxaparin, and 2.3% in patients receiving fondaparinux. GRACE risk score is the only independent risk factor of death. Mortality of NSTE-ACS patients is still high (6.4%). High GRACE score is a significant risk factor of in-hospital death. The use of fondaparinux as anticoagulant agent may improve survival. Further studies are needed to confirm this finding.