Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf Countries (Gulf COAST Registry)

Abstract

Objectives:The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries.Methods:Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013. Patient management and outcomes were analyzed and compared between the four countries.Results:A total of 1039 STEMI patients were enrolled in Gulf COAST Registry. The mean age was 58 years, and there was a high prevalence of diabetes (47%). With respect to reperfusion, 10% were reperfused with primary percutaneous coronary intervention, 66% with fibrinolytic therapy and 24% were not reperfused. Only one-third of patients who received fibrinolytic therapy had a door-to-needle time of 30 min or less. The in-hospital mortality rate was 7.4%. However, we noted a significant regional variability in mortality rate (3.8%-11.9%). In adjusted analysis, patients from Oman were 4 times more likely to die in hospital as compared to patients from Kuwait.Conclusions:In the Gulf countries, fibrinolytic therapy is the main reperfusion strategy used in STEMI patients. Most patients do not receive this therapy according to timelines outlined in recent practice guidelines. There is a significant discrepancy in outcomes between the countries. Quality improvement initiatives are needed to achieve better adherence to management guidelines and close the gap in outcomes.

Utility of shock index in 24,636 patients presenting with acute coronary syndrome

“…Our recent work showed a J-shaped relationship between shock index values and mortality in patients presenting with AHF. 18 Similarly, the overall ACS, NSTEMI and STEMI showed the same pattern and relationship.…”

“…The study cohort consisted of records of patients hospitalized with ACS in seven Arabian Gulf countries from 2005 to 2017. [16][17][18][19][20] All seven ACS registries had a prospective study design, two of which were national registries (Saudi Arabia and Kuwait), and used standard definitions according to published American College of Cardiology/ European Society of Cardiology guidelines during the conduct of each particular registry. 21 The databases were merged by using a standard uniform coding strategy after an extensive review of the original coding system of each registry.…”

Clinical review: Management of patients with acute ST-elevation myocardial infarction

“…Comparatively, the Gulf COAST registry shows that only 10% of all acute STEMI patients in Oman, Kuwait, UAE, and Bahrain undergo PPCI. [ 10 ]…”

“…This shows that adherence in the respective cardiac center compares favorably to centers in neighboring Gulf countries, as door-to-balloon time <90 min has been achieved in only 70%, 60%, and 50% in UAE, Kuwait, and Oman, respectively. [ 10 ] The Gulf COAST registry, based on data collected between January 2012 and January 2013 documents that the compliance with recommendations for door-to-balloon time not exceeding 90 min was 81% in Bahrain. [ 10 ] As this figure is very close to the compliance between January 2016 and January 2017 (80.9%), it indicates that the implementation of new strategies is needed to increase the compliance over the coming years.…”

Use of ticagrelor alongside fibrinolytic therapy in patients with ST‐segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

“…In other settings, treatment options may be even more limited: an observational study conducted in predominantly rural centers in China suggests that the proportion of patients with STEMI receiving early reperfusion therapy in this setting is only about 35% (compared with 60% in the centers included in EPICOR Asia) . In Arabian Gulf countries and Egypt, 55% to 69% of registry patients with STEMI received thrombolytic therapy and 10% to 37% underwent PCI . In contrast, in France, data from the French FAST‐MI registry show that 6% of patients with STEMI received intravenous fibrinolysis and 71% underwent primary PCI .…”