In-Hospital Complications among Patients with Acute Coronary Syndrome in a Tertiary Care Hospital in Pakistan: A Prospective Cohort Study
https://doi.org/10.5281/zenodo.17506007
Keywords:
Acute Coronary Syndrome, In-Hospital Complications, Risk Factors, Cardiogenic Shock, Mechanical Complications, LMIC, PakistanAbstract
Background: Acute Coronary Syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality. While traditional risk factors such as hypertension, diabetes, smoking, and dyslipidemia are well recognized, patients without these factors (SMuRF-less ACS) may also experience adverse outcomes. This study compared early in-hospital complications between ACS patients with and without traditional cardiovascular risk factors.
Objective: To assess and compare early in-hospital complications among patients with ACS based on the presence or absence of traditional cardiovascular risk factors.
Methods: This prospective cohort study was conducted at Mardan Medical Complex from July to December 2024. Patients with a confirmed diagnosis of ACS were enrolled and categorized into two groups: exposed (≥1 traditional risk factor) and non-exposed (without traditional risk factors). Clinical, electrocardiographic, and echocardiographic parameters were recorded at admission and at 24, 48, and 72 hours. Data were analyzed using IBM SPSS version 26.0. The Independent Samples t-test and Chi-square or Fisher’s Exact test were applied, with p < 0.05 considered significant.
Results: Of the 174 patients, 116 (66.7%) had one or more traditional risk factors. The mean age was comparable between the exposed and non-exposed groups (60.9 ± 11.8 vs. 59.8 ± 11.4 years; p = 0.54). Hemodynamic instability was significantly more frequent among exposed patients at admission (35.6% vs. 9.2%; p = 0.001) and at 72 hours (22.0% vs. 6.1%; p = 0.02). Mitral regurgitation (41.5% vs. 22.6%) and reduced left ventricular ejection fraction (18.9% vs. 6.1%) were more common among the exposed group, though not statistically significant. Arrhythmias were observed in both groups (6.9% vs. 5.7%). Overall, 11 in-hospital deaths occurred, with no significant difference between groups.
Conclusion: ACS patients with traditional risk factors experienced more frequent early in-hospital complications. However, SMuRF-less patients also demonstrated notable electrical and functional abnormalities, underscoring the need for vigilant monitoring and comprehensive risk assessment in all ACS cases.
