Primary coronary intervention versus thrombolytic therapy in myocardial infarction patients in the Middle East

Abstract

Background: Little is known about predictors and outcome differences of primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT) in ST-segment elevation myocardial infarction (STEMI) patients in the Middle East.

Objective: To compare predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients in six Middle Eastern countries.

Setting: Sixty-five hospitals (covering at least 85 % of the population) in Oman, United Arab Emirates, Qatar, Bahrain, Kuwait and Yemen.

Methods: This was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients who were admitted to 65 hospitals during May 8, 2006 to June 6, 2006 and from January 29, 2007 to June 29, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). Analyses were performed using univariate and multivariate statistical techniques.

Main outcome measures: Predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients.

Results: Out of 2,155 STEMI patients admitted to hospitals within 12 h of symptoms onset, 92 % received reperfusion (8 % PPCI and 84 % TT). TT use included reteplase (43 %), tenecteplase (30 %), streptokinase (25 %), and alteplase (2 %). Median age of the study cohort was 50 (44-58) years with majority being males (90 %). There were no significant differences in median onset time to presentation between the TT and PPCI groups (130 vs. 120 min; P = 0.422). Median door-to-needle time and door-to-balloon time were 45 min (29-75) and 75 min (58-120), respectively. Predictors of PPCI included prior PCI, hospitals with catheterization laboratory facilities as well as those involved with academia. Multivariate logistic regression model demonstrated that patients that had PPCI were less likely to have recurrent ischemic attacks than those that had TT (odds ratio, 0.18; 95 % CI, 0.06-0.56; P = 0.003).

Conclusions: The main reperfusion strategy for STEMI patients in the Arab Middle East region is thrombolytic therapy. Predictors of primary percutaneous coronary intervention included prior percutaneous coronary intervention, hospitals with catheterization laboratory facilities as well as those involved with academia. Primary percutaneous coronary intervention resulted in significant reductions in recurrent ischemic events when compared to thrombolytic therapy.