JNMA I VOL 52 I NO. 6 I ISSUE 190 I APR-JUN, 2013 316 Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Care Centre: The Spectrum and Coronary Risk Factors Mani Prasad Gautam, 1 Guruprasad Sogunuru, 1 Gangapatnam Subramanyam, 1 Lekh Jung Thapa, 2 Raju Paudel, 3 Madhav Ghimire, 3 Samir Gautam, 1 Usha Ghimire, 4 Ramila Silpakar 5 1 Department of Cardiology, 2 Department of Neurology, 3 Department of Nephrology, 4 COMAT, Kathmandu, Nepal, 5 Department of Medicine, College of Medical Sciences, Bharatpur, Nepal. ABSTRACT Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction. Its spectrum and incidence is crucial as a part of need assessment of cardiac catheterization laboratories. Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit of College of Medical Sciences Teaching Hospital, Bharatpur, Nepal from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed. Results: A total of 57 subjects were included in the study. The majority 36 (63.16%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. The major coronary heart disease risk factors were smoking 29 (50.88%), diabetes 25 (43.85%), hypertension 21 (36.87%), and previous history of coronary heart disease 18 (31.58%). ST elevation myocardial infarction was the major category 24 (42.11%) followed by non-ST elevation myocardial infarction and unstable angina 18 (31.58%) and 15 (26.32%), respectively. Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of hypertension, dyslipidemia, diabetes and obesity. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might improve the mortality and morbidity in such cases. _______________________________________________________________________________________ Keywords: acute coronary syndrome; coronary risk factors; intensive care unit. _______________________________________________________________________________________ ______________________________________ Correspondence: Dr. Mani Prasad Gautam, Department of Cardiology, College of Medical Sciences, Bharatpur, Nepal. Email: manigautam@gmail.com, Phone: 9851076043. INTRODUCTION Coronary Heart Disease (CHD) is one of the most common causes of preventable death and ranks second and third in male and female over 15 years of age respectively in terms of disease burden as judged by Disability-Adjusted Life Years lost. 1 There is a remarkable rise in CHD burden in low-income and middle-income countries. 2 The South Asians; India, Pakistan, Bangladesh, Sri Lanka, and Nepal account for about a quarter of the world's population and contribute the highest proportion of the burden of cardiovascular diseases as compared with any other region globally. 2-4 ORIGINAL ARTICLE J Nepal Med Assoc 2013;52(190):316-21 CC S BY NC OPEN ACCESS