INTRODUCTION:

Coronary heart disease (CHD), sometimes described as coronary artery disease (CAD), is a condition in which the vascular supply to the heart is impeded by atheroma, thrombosis or spasm of coronary arteries. This may impair the supply of oxygenated blood to cardiac tissue sufficiently to cause myocardial ischemia which, if severe or prolong, may cause the death of cardiac muscle cells i.e., Myocardial infarction (MI).

Less commonly, myocardial ischemia can also arise if oxygen demand is abnormally increased, as may occur in severe ventricular hypertrophy due to hypertension, or the oxygen carrying capacity of blood is impaired, as in iron deficiency anemia. The term ischemic heart disease may be used to include all causes of myocardial ischemia.^[1]

ACS are classified according to ECG changes into

1. ST segment elevation ACS (STEMI)

2. Non ST segment elevation ACS (NSTE ACS) which include necrotive myocytes into the blood stream. The cause of ACS in more than 90% of patients is rupture, fisses non–ST segment elevation myocardial infarction (NSTEMI) and unstable angina (UA).

Acute coronary syndrome arises from an unstable atheromatous plaque. The major feature of these lesions is the presence of overlying thrombus and associated inflammation of the vessel wall. Patients with acute coronary syndrome usually present with chest pain at rest and should be admitted to hospital for evaluation and treatment. The major difference in approach to these patients arises from whether the coronary artery involved is felt to be occluded or open. Patients with occluded coronary artery suffer myocardial damage, the extent of which is determined by duration and site of occlusion. The primary strategy for these patients is restoration of coronary flow with either thrombolysis or primary angioplasty. If the coronary artery is patent, however then therapy with thrombolysis is unnecessary and probably harmful, although angioplasty may still be appropriate. Once the vessel is open, for both groups of patients management then focuses on unstable coronary plaque and is therefore fundamentally similar.

The most important tool to help identify those patients in whom an artery is occluded is the ECG. The presence of ST elevation on the ECG correlates with the presence of occluded artery and is used to determine those patients who should receive thrombolysis or primary angioplasty. The presence of ST elevation on the ECG and ischemic chest pain is nearly always associated with myocardial damage confirmed by measurement of cardiac enzymes and plasma levels of troponin. These patients have therefore had an ST elevation MI (STEMI).

Patients without ST elevation on the ECG may still have myocardial damage due to temporary occlusion of vessel or emboli from the plaque related thrombus blocking smaller distal vessels and will have raised troponin values; these patients have had a non-ST elevation MI(NSTEMI). Patients without rise in troponin or cardiac enzymes and without ST elevation are defined as having unstable angina.^[2]

METHODS AND MATERIALS:

Patients with NSTEMI are identified and enrolled in the study after taking their consent for willing to participate in the study.

1. Number of patients will be 70

2. A prospective observational study is done by follow up of patients and all the details regarding the study are collected from inpatient records, medication charts and consulting health care officials when needed.

3. All the information that is required for the study will be collected in the data collection forms designed as per our study requirements.

4. The data collected will be recorded and simple statistical tools involving data graphics are used in interpreting results.

5. Finally results are represented with various graphical diagrams.

6. Inclusion Criteria:

7. Patients presenting with acute Non - ST elevated myocardial infarction of either sex.

8. Eligible patients were men or non pregnant women at least 18 years of age with recent onset of angina at rest lasting at least 10 minutes.

9. Patients who presented within 24hrs of onset of chest pain with a NSTEMI.

Exclusion Criteria:

1. Patients with age < 15 years and > 80 years.

2. Patients with angina with an established precipitating cause (e.g., heart failure or tachy dysrhythmia), contraindications to anticoagulation, or a creatinine clearance rate of less than 30 ml per minute.

Primary assessment:

Heamodynamic changes in patients receiving IV Paracetamol

Secondary assessment:

Applications in the clinical parameters.

Data collection:

1. All the relevant and necessary data will be collected from.

2. Inpatient records at Cardiology department.

3. Lab reports, medication charts or prescriptions.

4. Communicating with health care professionals.

5. By regular follow up of the patient regarding for above stated data collection.

RESULTS AND DISCUSSION:

In the current clinical research study we have performed a prospective observational study regarding prescribing patterns involving NSTEMI patients who are admitted in cardiology department. This study was conducted solely at Durgabai Deshmukh Hospital under expertise doctor guidelines. Extensive study of 6 months has been done on 70 subjects and results have been interpreted. These results will probably help to evaluate the deviations of prescribing patterns from the standard. Day to day observation of each patient was done in medication charts, dosing schedules, prescriptions were analyzed based on their length of stay in the hospital.

The recorded data of each patient was entered in to a data collection form which is designed to meet our study requirements. Results have been displayed below based on our objectives of study using histograms, pie diagrams and bar graphs.

TABULAR REPRESENTATION:

Table 1: Number of patients according to age and gender:

Age	Males	Females	Total
30-40	7	2	9(13%)
41-50	11	5	16(23%)
51-60	18	3	21(30%)
61-70	16	2	18(26%)
71-80	4	2	6(9%)
81-90	0	0	0(0%)
TOTAL	56(80%)	14(20%)	70

Fig1: Percentage of NSTEMI patients according to gender

Fig 2: Number of subjects according to their age

From the above table 1 it was concluded that, among 70 patients 56 are male i.e., (80%) and 14 are female (20%) as shown in (Fig.1).

Among all age groups major number of NSTEMI was seen in 51-60 years (30%) as shown in (Fig.2)

Table 2: Number of patients according to chief complaints:

S. No	Chief Complaint	Number of Subjects
1.	CHEST PAIN	56
2.	SWEATING	19
3.	SOB	21
4.	PALPITATION	9

Fig.3 Number of patients according to chief complaints

From the above table 2 it was concluded that 56 out of 70 patients i.e., 80% are with chest pain as chief complaint, 19 patients i.e., 27% are with sweating as chief complaint, 21 patients are with shortness of breath (SOB) as chief complaint i.e., 30% and 9 patients are with palpitations as chief complaint i.e., 13% respectively.

Table 3: Number of patients with major complications:

S. No	Complication	Number
1.	GI BLEEDING	8
2.	IC BLEEDING	1

Fig.4 Number of patients with major complications

From the above table 3 it was clear that 8 out of 70 patients suffered gastric bleeding i.e., 11.4% and 1 out of 70 patients suffered from intracranial bleeding i.e., 1.42% respectively

Table 4: Number of patients with minor complications:

S. No	Complication	Number
1.	HEART FAILURE	9
2.	TACHYARRTHYMIA	22
3.	LOCAL BLEEDING	13

Fig. 5 Number of patients with minor complications.

From the above table it is clear that 9 patients out of 70 suffered with heart failure i.e., 12.85%, 22 patients out of 70 suffered with tachyarrhythmia i.e., 31.4%, and 13 patients suffered local bleeding i.e., 18.57% respectively

Table 5: Number of patients with complications in both regimens:

S. No	Complications	Regimen 1	Regimen 2
1.	GI BLEEDING	3	5
2.	IC BLEEDING	0	1
3.	HEART FAILURE	4	5
4.	TACHYARRTHYMIA	10	12
5.	LOCAL BLEEDING	4	9
	TOTAL	21	32

Fig. 6 Number of patients with complications.

RELATIVE RISK:

Rate per 1000

22/33*1000 = 6.363636

32/37*1000 = 8.64864

Relative risk = 6.363636 / 8.64864

= 0.7357

1-0.7 = 0.27

i.e., 0.27*100 = 27%

From the above study it is concluded that 21 out of 33 suffered with complications by administering low molecular weight heparin (regimen 1) and 32 out of 37 suffered with complications by administering un fractionated heparin (regimen 2) and it is concluded that 27% risk is more observed in regimen 2 than regimen 1 until the limited follow up that has been done.

DISCUSSION:

In previous studies, paracetamol was compared with the other antipyretic and analgesic drugs and also they have conducted studies in post operative women, patients with other comorbid conditions and the changes in blood pressure were seen. In our study we have taken single drug therapy. Patients included were only with fever and pain conditions.

CONCLUSION:

In this study we evaluate the common prescribing patterns in NSTEMI patients. We also see the deviations from the prescribing patterns, the reasons for the deviation. The following points have been established in our study that among 70 patients 56(80%) are males and 14 (20%) are females, all age groups major numbers of NSTEMI patients are seen in 51-60 years (30%). among all patients 56 out of 70 patients i.e., 80% are with chest pain as chief complaint, 19 patients i.e., 27% are with sweating as chief complaint, 21 patients are with shortness of breath (SOB) as chief complaint i.e., 30% and 9 patients are with palpitations as chief complaint i.e., 13%, all patients 8 out of 70 patients suffered gastric bleeding i.e., 11.4% and 1 out of 70 patients suffered from intracranial bleeding i.e., 1.42%, all patients 9 patients out of 70 suffered with heart failure i.e., 12.85%, 22 patients out of 70 suffered with tachyarrhythmia i.e., 31.4%, and 13 patients suffered local bleeding i.e., 18.57% . From the above study it is concluded that 21 out of 33 suffered with complications by administering low molecular weight heparin (regimen 1) and 32 out of 37 suffered with complications by administering un fractionated heparin (regimen 2) and it is concluded that 27% risk is more observed in regimen 2 than regimen 1 until the limited follow up that has been done.

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Received on 17.07.2019 Modified on 15.08.2019

Research J. Pharm. and Tech. 2020; 13(7): 3151-3155.

DOI: 10.5958/0974-360X.2020.00557.0