NCVD Acute Coronary Syndrome ACS Registry An Update

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)

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

Current Activities 1. Report: NCVD-ACS Registry Annual report year 2006 Downloadable online at http: //www. acrm. org. my/ncvd/publications. htm National Cardiovascular Disease Database (NCVD)

Current Activities 2. NCVD-ACS Registry Annual Report year 2007 • Currently in the midst of datacleaning stage 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 Baseline (n= 10, 730) Age Min, Max mean + sd 18. 33, 99. 52 yrs 59. 05 + 11. 99 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)

Smoking Status 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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

CV Risk Factors 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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

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

Number of distinct angina episode within 24 hrs No episode 14. 42 % 8 0. 02 % 1 36. 38 % 9 0. 02 % 2 7. 52 % 10 0. 07 % 3 2. 73 % 11 0. 02 % 4 0. 71 % 12 0. 01 % 5 0. 38 % 14 0. 03 % 6 0. 14 % 20 0. 01 % 7 0. 06 % NA 37. 48 % Results as of 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

Clinical Examination Heart Rate 83. 5 beats/min Systolic BP 139. 74 mm. Hg Diastolic BP 81. 12 mm. Hg 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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

ECG abnormalities type Baseline (n= 10, 864) ST-segment elevation ≥ 1 mm (0. 1 m. V) in ≥ 2 contiguous limb leads 17. 31 % ST-segment elevation ≥ 2 mm (0. 2 m. V) in ≥ 2 contiguous frontal leads or chest leads 31. 16 % ST-segment depression ≥ 0. 5 mm (0. 05 m. V) in ≥ 2 contiguous leads 24. 57 % T-wave inversion ≥ 1 mm (0. 1 m. V) 20. 54 % Bundle branch block (BBB) 4. 95 % Non-specific 5. 23 % None 6. 01 % Not stated / inadequately described 1. 86 % Results as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

ECG abnormalities location Baseline (n= 10, 864) Inferior leads : II, III, a. VF 31. 42 % Anterior leads : V 1 to V 4 41. 96 % Lateral leads : I, a. VL, V 5 to V 6 30. 23 % True posterior : V 1 V 2 4. 58 % Right ventricle : ST elevation in lead V 4 R 3. 77 % None 9. 86 % Not stated / inadequately described 3. 89 % 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)

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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

Fibrinolytic Drug Used (n=2, 861) Streptokinase 91. 68 % Others 2. 31 % Missing 6. 01 % Door to needle time (mins) 94. 36 + 145. 24 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 9 th April 2009 National Cardiovascular Disease Database (NCVD)

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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD) 233. 77 + 292. 63

Pharmacological Therapy Drug used/given during admission (%) Drug Preadmission 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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

Pharmacological Therapy Drug used/given during admission (%) Preadmission 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 Drug Results as of 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

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 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

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

Overall Follow Up Management Type of FU 30 days FU 1 year FU Total Expected visits N 9650 % N 7604 % FU Done Missed FU 6493 3157 67. 28 32. 72 3352 4252 44. 08 55. 92 Results as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

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

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

Cardiovascular readmission 30 days (n= 6, 550) 1 year (n= 3, 374) 3. 89 % 2. 07 % 14. 51 % 14. 90 % 53. 73 % 16. 86 % 12. 86 % 7. 14 % 61. 43 % 11. 43 % Heart Failure 0. 49 % 0. 53% Revascularization 5. 15 % 3. 11% PCI 87. 54 % 78. 09 % CABG 9. 79 % 15. 24 % 0. 11 % 0. 06 % ACS STEMI NSTEMI UA Missing Stroke Results as of 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

Outcome at 30 days & 12 months 30 days (n= 6, 550) 1 year (n= 3, 374) Alive 85. 39 % 84. 53 % Death 3. 45 % 2. 31 % Lost to FU 8. 98 % 10. 58 % Transferred 0. 58 % 0. 18 % Missing 1. 6 % 2. 4 % 30 days (n= 226) 1 year (n= 78) Outcome Cause of Death CVD 55. 31 % 47. 44 % Non CVD 10. 62 % 8. 97 % Others 13. 27 % 21. 79 % Missing 20. 80 % 21. 80 % Results as of 9 th April 2009, n= 10, 864 National Cardiovascular Disease Database (NCVD)

Thank you National Cardiovascular Disease Database (NCVD)