Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction

Abstract

Background Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries. Results Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%. Conclusion Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.

Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients

“…This could be due to the close proximity of hospitals to the patients or the delay of EMS response in an overcrowded city. Similar results were reported in an earlier registry where EMS service was under-used (14%) among Egyptian patients presenting with STEMI [ 11 ]. Self-presentation rather than EMS-presentation and presenting to a non-PCI capable hospital are additional causes for pre-hospital delay in Egypt [ 2 ].…”

“…In the 2012 Egyptian STEMI Registry, 65.5% received streptokinase while only 12.4% had primary PCI [ 18 ]. In a more recent registry, the rate of Primary PCI was 49.12% while the rate of thrombolysis was 43.07% [ 11 ]. In the present study, the use of streptokinase declined from 36.4% to 7.5% (P > 0.001) after the implementation of the STEMI network.…”

Pattern of risk factors and Short Term Outcome in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction

“…On the other hand, the lesions in older age group are predominantly calcified with less positive remodeling. This discrepancy between both studies (ours and the other) could be explained by the high prevalence of smoking among both old and young Egyptians as shown in our work and supported by [14].…”

The Complexity of Peripheral Arterial Disease and Coronary Artery Disease in Diabetic Patients: An Observational Study

“…Most of the studied Egyptian cohort were males, smokers, hypertensives, with high LDL levels and inadequate glycemic control. Where these represent the traditional risk factors for atherosclerosis with high prevalence among the studied group, they were shown in the registry published by Shaheen et al [ 8 ] in the European Society of Cardiology Registry on ST elevation MI; compared to other countries, Egyptian patients had higher prevalence of traditional risk factors.…”