Acute heart failure complicating acute coronary syndromes in patients admitted to Coronary Care Unit - Cardiac Center , Al-Thawra Hospital - Sanaa, Yemen

Abstract

Background: Heart Failure with all its types and presentation is the end result of acute coronary syndrome. Coronary artery disease and its acute manifestations of ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina are remarked as acute coronary syndromes (ACS). Yemeni patients usually present themselves to hospital late due to a lack of society awareness of the symptoms of ischemic heart disease, absence of medical insurance, poverty, lack of medical aid and intensive care units (ICU), absence of ambulance services, and long distance to the facilitated hospital with equipped ICUs. Late presentation prevents giving thrombolytic therapy or performing invasive interventions within the right time. These factors in addition to other factors may contribute to the large number of heart failure post ACS. We designed this study to study the heart failure complicating acute coronary syndrome.

Results: Out of 637 patients with ACS, 294 (39%) were in heart failure complicating ACS, with a median age of 51 years. Males represent 66% (194 patients) and females 34% (100 patients). Smoking represents 36%, khat chewing 88%, hypertension 53%, dyslipidemia 31%, past history of MI 29%, and diabetes mellitus 40%. Ischemic-type chest pain represents 49% and Dyspnea as primary symptom occurred in 29% with heart failure (HF). Late presentation of more than 12 hours represents 53% (111 patients) among patients with HF complicating STEMI or LBBB MI. These patients did not receive thrombolytic therapy or primary PCI. Patients who received thrombolytic therapy represent 45% (95 patients) of patients with HF-complicating ACS. No patients received primary PCI.

Conclusions: Heart failure complicating ACS is common among our patients and associated with high in-hospital death and is mainly among young patients and related to late presentation, management with non-fibrine specific thrombolytic agents (streptokinase), and lack of STEMI catheterization team for 24 hours, seven days a week.