Evaluation of Mortality Among Patients of Acute Coronary Syndrome with Frontal QRS-T Angle > 100 Presenting to Tertiary Care Hospital

Haseeb Hassan; Erum Arshad; Muhammad Salman Musharraf; Zaheer Ahmad; Muhammad Zeeshan Aslam; Zakria Anwer

doi:10.29054/apmc/2020.61

Haseeb Hassan Consultant Cardiologist, Kingdome of Saudi Arabia
Erum Arshad Post Graduate Trainee, Department of Medicine, Postgraduate Medical Institute, Lahore Pakistan
Muhammad Salman Musharraf Medical Officer, Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad Pakistan
Zaheer Ahmad Senior Registrar, Department of Neurology, Allied Hospital, Faisalabad Pakistan
Muhammad Zeeshan Aslam Consultant Rheumatologist, DHQ Hospital, Faisalabad Pakistan
Zakria Anwer Senior Registrar, Medicine Allied Hospital, Faisalabad Pakistan

DOI: https://doi.org/10.29054/apmc/2020.61

Keywords: ACS, QRS - T angle, Cardiac Mortality

Abstract

Background: Cardiovascular disease (CVD) alone was responsible for 30% of 58 million deaths world over. ACS includes Unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infection (STEMI). Chest pain often described as heaviness, squeezing sensation or discomfort is most commonly reported symptom in patients with ACS. An increasing trend is seen in burden of ACS in Pakistan population with increasing presentation as STEMI. The diagnosis of ACS is usually made on typical changes on electrocardiogram and on raised in cardiac biomarkers. However, studies are being conducted to determine the outcome predictors in patients with ACS. Indeed, relationship exists between PR and QT intervals, heart rate (HR), QRS duration and P, QRS and T waves axis and cardiovascular outcomes. It is of note that the frontal T axis and spatial QRS T angle also predict mortality. Objective: Our objective was to determine the frequency of mortality within 15 days among patients of acute coronary syndrome with frontal QRS-T angle > 100 presenting to tertiary care hospital. Study Design: Descriptive case series. Settings: Department of cardiology, Jinnah hospital, Lahore. Duration: Six months from 19-01-2016 to 19-06-2016. Methodology: One hundred eighty (180) patients presenting to ER department with ACS were offered to be enrolled in the study. Informed consent was obtained from all patients and study protocol was explained. Patients were treated according to department protocols. Patients with QRS-T angle >100 was followed for 15 days through regular visits to outdoor departments and telephonic contact. Results: A total of 180 patients presenting to emergency department of cardiology, Jinnah hospital, Lahore with acute coronary syndrome were enrolled in the study. The mean age of the subjects was 52.72 ± 16.15 years with minimum and maximum ages of 20 & 80 years respectively. In this study 135 (75%) subjects were male while 45 (25%) were females. Frequency of types of Acute Coronary Syndrome was evaluated and 104 (57.8%) cases were found of ST-segment Elevation MI, 39 (21.7%) were of Non-ST Elevation MI, while 37 (20.6%) were of unstable Angina. The study results showed that among the subjects, 33 (18.3%) were dead within 15 days, 147 (81.7%) survived among the subjects. So, Mortality rate was found 18.3% among the subjects. Conclusion: Our study shows that the frequency of mortality seen in patients with QRS - T angles was 18.3%.