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. 2017 Apr-Jun;18(2):41-46.
doi: 10.4103/HEARTVIEWS.HEARTVIEWS_113_16.

Disparity in ST-segment Elevation Myocardial Infarction Practices and Outcomes in Arabian Gulf Countries (Gulf COAST Registry)

Mohammad Zubaid  1 , Wafa Rashed  2 , Alawi A Alsheikh-Ali  3   4 , Taysir Garadah  5 , Najib Alrawahi  6 , Mustafa Ridha  7 , Mousa Akbar  8 , Fahad Alenezi  9 , Rashed Alhamdan  10 , Wael Almahmeed  11 , Hussam Ouda  12 , Arif Al-Mulla  13 , Fahad Baslaib  14 , Abdulla Shehab  15 , Abdulla Alnuaimi  16 , Haitham Amin  17
Affiliations

Disparity in ST-segment Elevation Myocardial Infarction Practices and Outcomes in Arabian Gulf Countries (Gulf COAST Registry)

Mohammad Zubaid et al. Heart Views. 2017 Apr-Jun.

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.

Keywords: Arabian Gulf; Middle East; ST-segment elevation myocardial infarction; registries.

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Conflict of interest statement

The authors Zubaid, Alsheikh-Ali, AlMahmeed receive speaking honoraria from Sanofi and Boehringer Ingleheim and Astra Zeneca.

References

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