Planificación y ejecución de la convivencia en el aula: código de

3.9.1 Hypertension: This was defined based on JNC – 7 criteria as positive history of hypertension, use of anti hypertensive drugs or blood pressure equal to or greater than 140/90mmHg measured using standard procedure.^3,4,111

3.9.2 Diabetic mellitus: This was defined based on world health organization (WHO) criteria as fasting blood sugar (FBS) greater than or equal to 126mg/dl (7.0mmol/l) and or random blood sugar (RBS) greater than or equal to 200mg/dl (11.1mmol/l). One abnormal blood sugar value in the presence of typical symptoms of DM, or at least two abnormal blood sugar values if there are no typical symptoms was used for diagnosis of diabetes. Previously diagnosed DM was considered even if glucose control has been achieved at the time of the study.^3,4

.3 Dyslipidaemia: This was defined using Adult Treatment Panel III (ATP III) guidelines, when one or all of the following were found: Total cholesterol greater than or equal to 200mg/dl (5.2mmol/l), low density lipoprotein cholesterol greater than or equal to 130mg/dl (3.3mmol/l), triglycerides greater than or equal to 150mg/dl (1.7mmol/l) and high density lipoprotein cholesterol less than or equal to 40mg/dl (1.03mmol/l) in men or less than or equal to 50mg/dl (1.3mmol/l) in women.^3,4

3.9.4 Obesity: This was defined based on WHO guidelines as waist circumference of greater than or equal to 102cm in men and greater than or equal to 88cm in women or BMI greater than or equal to 30kg/m².^2,3

3.9.5 Smoking: This was classified into (a) Current smokers were defined as those who smoked at least one cigarette per day or have stopped cigarette smoking during the past 12 months. (b) Former smokers were defined as those who had stopped smoking for more than one year. (c) Non smokers were defined as those who have never smoked cigarette in their life.^3,4,29

3.9.6 Family history of CVD: This was defined as a positive history of IHD in a first degree relative before the age of 55 years for men and 65 years for women, history cardiovascular risk factor in first degree relative or history of sudden cardiac death before the age of 55 years for male and 65 years for female in first degree relative.^3,4

3.9.7 Advanced age: This was defined as age greater than or equal to 65 years.^3,39

3.9.8 Excessive alcohol intake: Alcohol intake was considered to be excessive at levels above 21 units weekly (3 unit/day) for men and 14 units weekly (2 unit/day) for women. One unit contains approximately 9 gram of alcohol and is equivalent to half a pint of beer, a single measure of spirit or glass of wine.^28,30

3.9.9 Physical activity: This was graded according to occupation: ^28,37 (1) Very active (carrying or lifting heavy loads, digging or construction work). (2) Moderately active (work involving brisk walking or carrying light loads such as housework, trade work and nursing. (3) Not active (sitting or reclining for most part of the day in a week such as office work and unemployment).

3.9.10Social status: The subjects in this study were group into five social classes according to the Registrar General’s Classification.⁷¹ as shown in Table below.

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THE REGISTRAR GENERAL'S (BRITIAN) SOCIAL CLASS CLASSIFICATION:⁷¹ SOCIAL CLASS DESCRIPTION EXAMPLES

I Professionals Doctors, Lawyers

Businessmen/Women Large employers

II Lesser professionals Teachers

Trade Shopkeepers

III N Skilled non-manual Clerical workers

III M Skilled manual Electricians Lorry drivers

IV Semi-skilled manual Farm workers

Machine operators Masons

V Unskilled manual to Farm workers,

Unemployed Labourers

Adopted from Morris 1975.

3.9.11 ST – segment elevation: This was defined as ST segment elevation of more than or equal to 1mm from the iso-electric line in two contiguous limb leads or more than or equal to 2mm in two contiguous chest leads.⁴

.12 ST – segment depression: This was defined as ST segment depression of more than or equal to 1mm from iso-electric line in two contiguous limb leads or more than or equal to 2mm in two contiguous chest leads with T wave inversions.³

3.9.13 Pathological Q waves: This was defined as when Q waves are more than or equal to 0.04 seconds in duration and more than one fourth of the R – wave in amplitude.^3,4

3.9.14 Presumed new LBBB: This was defined as broad QRS complex of greater than or equal to 0.12 seconds with presence of notched R wave in V6 and broad and deep S wave in V1 in

patient previously known not to have LBBB.⁴

3.9.15 Localization of ACS (STEMI only): The site of infarct was localized as follows: Inferior wall MI (limb leads II, III and aVF), anterior wall MI (chest leads V1 and V2), lateral wall MI (lead I, aVL, V5 and V6), septal wall MI (chest leads V3 and V4), antero-septal wall MI (chest leads V1

to V4), extensive anterior wall MI (chest leads V1 to V6).⁴

3.9.16 Regional wall motion abnormality: This was defined as either a reduction of a segment in more than 30% or absent systolic thickening of a segment when it is compared with adjacent

segments. While abnormal systolic wall motions on the other hand can be hypokinesia, akinesia, dyskinesia or aneurysm. This were assessed by looking at the infarcted myocardial segment during systole for reduction, absence, paradoxical outward movement or out pouching of all layers of the wall respectively.³³ The American society of echocardiography has recommended 15 segments model. Each segment is assigned score on the basis of its contractility as assessed visually: normal is 1, hypokinesia is 2, akinesia is 3, dyskinesia is 4 and aneurysm is 5.³³ The areas of the left ventricle which can be seen from various echocardiographic views are: (1) inter ventricular septum (2) left ventricular apex (3) anterior wall (4) lateral wall (5) inferior wall. On two dimensional imaging, the LV can be divided into several segments. This is useful to localise the site of ischaemia or infarction and to quantify its extent. Each wall can be further divided into basal (proximal), mid and apical (distal) segment.

3.9.17 Wall motion score index (WMSI): This is the sum of wall motion scores divided by number of segments visualized. A normally contracting LV has a WMSI of 1 (each of the 15 segments receives a wall motion score of 1, hence, the total score is 15 and WMSI is 15/15 = 1).

Therefore WMSI more than 1 is considered abnormal.³³

3.9.18 STEMI: This was diagnosed when there is ST segment elevation or presumed new LBBB on their ECG with elevated cardiac troponin T in the presence of ischaemic symptoms.⁴

3.9.19 NSTEMI: This was diagnosed when there is elevated cardiac troponin T with ECG evidence of ST segment depression or T wave inversion in the presence of ischaemic symptoms.³ 3.9.20 Unstable Angina: This was diagnosed when there is a new or accelerated ischaemic symptoms and with ECG evidences of ST segment depression or T wave inversion in the absence of elevated cardiac troponin T.³

3.9.21 Ischaemic symptoms: This was defined as typical chest pain, discomfort, heaviness that radiate to the arm, shoulder, neck, back, epigatrium. Symptoms exacerbated by exertion or stress and relieved by rest. Symptoms associated with shortness of breath, dyspepsia, palpitation, diaphoresis, weakness, nausea, vomiting or light-headedness.^3,4,74

3.9.22 Positive troponin: This was defined as troponin T greater than or equal to 0.4ng/ml.^3,4,75 .23 Renal impairment: This was defined as serum creatinine greater than or equal to

132µmol/l (greater than or equal to 1.5mg/dl).^69,83,109

3.9.24 Anaemia: This was defined as haemoglobin less than or equal to 12g/dl.^68,83

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3.9.25 Hyperglycaemia: This was defined as RBS greater than or equal to 11.1mmol/l at presentation.^3,4

3.9.26 In-hospital mortality: This was defined as death while on admission.

3.9.27 Optimal medical therapy: This was defined as combination of maximum number of drugs with proven benefit (4 to 5 of aspirin, clopidogrel, statins, ACEI/ARB and beta blockers) received by a patient.^3,4

3.9.28 Left ventricular systolic dysfunction: This was defined left ventricular ejection fraction less than 50%.³³

3.9.29 Left ventricular diastolic dysfunction: This was classified into (a) Normal diastolic filling pattern is defined as values of E/A = 1.0 to 1.5 and DT = 160 to 240ms. (b) Grade 1 diastolic dysfunction (Impaired relaxation) is defined as reduced E/A less than 1.0 and prolonged DT greater than 240ms. (c) Grade 2 diastolic dysfunction (Pseudo normal pattern) is defined as E/A 1.0 to 1.5, DT 160 to 240ms, e’ less than 10cm/s and E/e’ greater than 15. (d) Grade 3 diastolic dysfunction (Restrictive filling Pattern) is defined as increased E/A greater than 1.5 and reduced DT less than 160ms. (E= early rapid filling wave, A= filling wave due to atrial contraction, DT = deceleration time, e’ = lateral mitral annular early diastolic filling wave, E/e’ =

left ventricular filling pressure).³³ 3.10 Data analysis

The questionnaire was manually checked for accuracy and completeness. All data collected were entered and analyzed using computer based statistical package for social sciences (SPSS), for windows version 18.0.0 (July 30, 2009). Quantitative variables were presented as means and standard deviations. Qualitative variables were presented as proportion and percentages.

Categorical variables were compared using Chi square test or Fisher Exact test as appropriate.

Student’s t test was used to compare difference in means between 2 groups of continuous variables, while difference in means between 3 or more groups of continuous variables were compare using analysis of variance (ANOVA). The predictors of in-hospital mortality were first identified using univariate analysis. Factors that were identified as significant predictors of inhospital mortality under univariate analysis were used in multiple logistic regression model aimed at determining the independent predictors associated with in-hospital mortality. Odd ratio at 95% confidence interval was calculated. P value of less than 0.05 was considered as

statistically significant.