ASSESSMENT OF SECONDARY PREVENTION GOALS ACHIEVEMENT AMONG PATIENTS WITH RECURRENT ACUTE CORONARY SYNDROME AT A TERTIARY CARDIAC CENTRE IN PAKISTAN

Abstract

Objective: To assess the achievement of secondary prevention targets in patients with recurrent acute coronary syndrome (ACS) in a tertiary cardiac centre in Pakistan. Study Design and setting: This was a cross-sectional study, which was carried out in the Cardiology Department of Tabba Heart Institute, Karachi, Pakistan, for six months. Methods: Patients were recruited if they were 18–75 years old and either male or female, and were admitted with a repeat acute coronary syndrome (ACS) (ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina) with a prior event at least one year before. The composite secondary prevention endpoint was considered to be the achievement of all six targets. SPSS version 22 was used for analyzing data. The p value of <0.05 was considered statistically significant. Results: The median age was 61.0 years (IQR 53.0–68.0), and 66.9% were male. Overall, 71.0% of patients had blood pressure controlled, 44.4% had LDL-C target and 50.9% (36.2% if diabetics only) had HbA1c target. Antiplatelet therapy was employed in 87.0% of the patients and high intensity statin therapy in 78.1%. Only 9.5% achieved the composite secondary prevention goal. The geriatric age was an independent predictor of BP control (OR 1.04, p = 0.042) and of HbA1c goal (OR 1.05, p = 0.040). Male sex was independently associated with better BP control (OR 3.07, 95% CI 1.43–6.56, p = 0.004). Conclusion: Achievement of secondary prevention targets among patients with repeat  ACS remained suboptimal, with particularly low rates of lipid and glycemic control and very limited attainment of composite goals.