COMPARISON OF THE INCIDENCE AND RISK FACTORS OF ACUTE CORONARY SYNDROME IN JAPAN AND THAILAND: A RETROSPECTIVE COHORT STUDY

Abstract

BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of premature mortality worldwide. Incidence is declining in high-income nations but rising in low-and middle-income countries, highlighting the need for cross-country comparisons to inform prevention strategies. OBJECTIVE: To compare the incidence and risk factors of ACS between Japan and Thailand. DESIGN AND SETTING: A retrospective cohort study included 93 ACS patients from Burapha University Hospital, Thailand, and 177 from Wakayama Medical University, Japan, between January and December 2021. Participants were recruited using purposive sampling. MAIN OUTCOME MEASURES: Data from electronic medical records and meteorological databases were analyzed using descriptive statistics, chi-square/Fisher’s exact test, Student’s t-test, and Pearson’s correlation. RESULTS: There was no significant difference in the onset time of ACS between Japan and Thailand. Japanese patients were older, had more comorbidities, and more frequently presented with STEMI (66% vs. 24%), whereas Thai patients were younger, had a higher BMI (24.3 vs. 22.9 kg/m²), and more often presented with NSTEMI. In Thailand, meteorological analysis revealed negative correlations between temperature and humidity (r=–0.607, p < 0.001), atmospheric pressure and humidity (r=–0.502, p < 0.001), and temperature and pressure (r=–0.356, p < 0.001). CONCLUSIONS: Although ACS onset time did not differ, notable demographic, clinical, and meteorological variations were observed between Japan and Thailand. Japanese patients were older with more comorbidities and more STEMI, whereas Thai patients were younger with higher BMI and more NSTEMI; meteorological factors correlated with ACS onset in Thailand, underscoring the need for tailored, country-specific prevention strategies.