2 Mahosot Hospital, Vientiane, Lao PDR An observational study of 30-day morbidity and mortality of patients with acute coronary syndrome admitted to the cardiovascular ward, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic 1 Thatspahone Somsaart, M.D; 2 Pheng Sackda, M.D; 3 Molina Choummanivong, MD 1,3 Faculty of Post Graduate Studies, University of Health Sciences, Lao PDR. 2 Mahosot Hospital, Vientiane, Lao PDR

Introduction Method Objective Coronary heart disease (CHD) is the leading cause of mortality in the world1. In Laos, the diagnosis and treatment of CHD is more difficult, in part because of a lack of facilities, in particular the lack of access to certain laboratory tests, limited medical reperfusion therapy, and no percutaneous coronary intervention /coronary revascularization2. Additionally, due to poverty and low education, patients are often not aware that they have coronary artery disease, are unable to access or afford health care, and present late in the disease course3. Method All patients diagnosed with acute coronary syndrome (ACS) admitted to the cardiovascular ward at Mahosot Hospital, from February 2016 to June 2017, were enrolled. The patients were evaluated in hospital, and followed up by phone during the 30 days after discharge. Objective To describe 30-day morbidity and mortality of patients with ACS in Lao P.D.R.

Results Fifty-three patients were enrolled to the study. Six patients were lost to follow up. Forty-seven patients were included. All patients aged 37 to 86 years, with the mean age of 62 years. Clinical presentation N=47

AHF with cardiogenic shock with ECG changes AHF: Acute Heart Failure. STEMI: ST segment Elevation Myocardial Infarction

All deaths from cardiogenic shock Reasons for not receiving streptokinase (SK) included patient refusal due to concern for side effects (n =1) and SK shortage (n=7). All deaths from cardiogenic shock Readmissions (n =3) Heart failure Recurrent myocardial infarction Supraventricular tachycardia

Discussion Conclusion Fewer of our STEMI patients (12.9%) received streptokinase than in others studies in the region (at Roi-Et, Thailand4 26.7%, and Surin, Thailand5 35.13%), in part due to drug shortages. We had a higher percentage of patients with AHF and cardiogenic shock patients than at Surin hospital6, 21.3% vs. 10.81%, but our mortality rate was less than both regional studies (12.8% compared to 17.8%4, and 25.23%5). This may be because of a small sample size, and they all studied only in STEMI patients. Additionally, few patients were readmitted after discharged. Conclusion Our study shows that many patients with ASC had AHF. Among AHF patients, over half of them had cardiogenic shock, especially patients with STEMI, and many patients died in hospital. Additionally, many patients did not receive thrombolysis, despite being eligible. Limitations The primary limitation is the small sample size. Our patients with cardiogenic shock and death were all STEMI.

Acknowledgement References Faculty of Postgraduate Studies, University of Health Sciences The Heart Center, Mahosot Hospital Kristina Krohn, MD, Health Frontiers Coordinator References Global health estimate 2015: leading causes of death. http://www.who.int/healhinfo/global_burden_disease/en/ Pheng Sackda.,MD. Mahosot hospital, Vientiane, Lao PDR 2016 Yariv Gerbera, Uri Goldbourta,c and Yaacov Droryb for the Israel Study Group on First Acute Myocardial Infarction. Interaction between income and education in predicting long-term survival after acute myocardial infarction. European Journal of Cardiovascular Prevention and Rehabilitation 2008, Vol 15 No 5 บุญยงค จิรสุวรรณกุล, M.D. บุษบา วงค พิมล, R.N. จุฑามาส ประจันพล, R.N. อัตราตายและผลลัพธ์การดูแลรักษาผู้ป่วยโรคหัวใจขาดเลือดเฉียบพลันชนิด ST Elevation Myocardial Infarction ภายหลังการพัฒนาระบบการใช แบบแผน การดูแลรักษาแบบช องทางด วน . ขอนแกนเวชสาร ปี ที่ 35 ฉบับที่ 1 มกราคม - เมษายน 2554 ถาวร ชูชื่นกลิ่น . Acute ST elevation Myocardial Infarction at Surin hospital. วารสารรรการแพทย์ โรงพยาบาลครีสะเกษ สุรินทร์ ลุริรัมย์. ปีที่ 23 ฉบับที่ 1 (2) มกราคม-เมษายน 2551 bee_thatsaphone@outlook.com