الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute coronary syndrome (ACS) is applied to patients in whom there is a suspicion of myocardial ischemia. There are three types of ACS: ST elevation (formerly Q-wave) myocardial infarction (MI) (STEMI), non-ST elevation MI (NSTEMI) (formerly non-Q wave), and unstable angina (UA). The first two are characterized by a typical rise and/or fall in biomarkers of myocyte injury.
Acute MI is a clinical syndrome for which a constellation of subjective and objective parameters need to be assessed. The diagnosis must be obtained rapidly and accurately, and misdiagnosis can have catastrophic sequelae.
The identification of risk factors, such as smoking, known cholesterol elevation, diabetes, hypertension, and family history, is a supportive piece that helps to put the acute history into context. The chest discomfort that causes the patient to seek medical attention is usually sustained (>20 minutes), but can be stuttering.
The aim of this study was to evaluate the predictors of in-hospital mortality and morbidity regarding heart failure, cardiogenic shock, reinfarction and major bleeding in patients with acute MI across the spectrum of Egyptian patients in the registry of acute coronary syndrome.
This study is retrospective one which derived from the center of excellence (COE) registry of myocardial infarction in Egyptian patients which started July 2009 until now. Patients enrolled in the study were at least 18 years old and were admitted to hospital with ST elevation myocardial infarction or non ST elevation myocardial infarction.
The current study was carried out on 3518 adult patients of both genders; and all were diagnosed as acute myocardial infarction (MI) in 5 Egyptian hospitals in Cairo and Alexandria including two university-affiliated public hospitals, one private hospital, one public hospital affiliated to ministry of health, one university affiliated hospital.
In this study multiple items were described such as Demographics, history of the patients as regard risk factors, current medications, comorbidites, physical examinations, patients arrival and site of first evaluations and admission, type of MI, presentation, medications were given during first 24 hours, during hospital stay and at discharge ,diagnostic equipments, interventions as regard reperfusion therapy and length of stay.
In this study our main concern was on the parameters which have global agreements as the most important predictors of MI morbidity and mortality including age, gender, MI pattern, delayed arrival, prior IHD, history of prior MI, history of prior heart failure, history of hypertension, history of DM, history of dyslipidemia, history of current or recent smoking, family history.
After we did a multivariant analysis as regard outcomes (heart failure,cardiogenic shock, reinfarction, major bleeding, cerebrovasular accident and mortality) from multiple logistic regression analysis we found that all variables have a statistical significance alone before adjustment but after adjustment of these variables in front of each other the predictors have a significance affecting the prognosis in acute MI patients were the age (95%C.I 1.032-1.08 and P=.000) and smoking paradox (95% C.I 0.306-0.968 and P=.039).