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Multicenter Study
. 2019 May 21;14(5):e0216551.
doi: 10.1371/journal.pone.0216551. eCollection 2019.

The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)

Khalid F Alhabib  1 , Abdulhalim J Kinsara  2 , Saleh Alghamdi  3 , Mushabab Al-Murayeh  4 , Gamal Abdin Hussein  5 , Shukri AlSaif  6 , Hassan Khalaf  7   8 , Hussam Alfaleh  1 , Ahmad Hersi  1 , Tarek Kashour  1 , Ayman Al-Saleh  1 , Mohammad Ali  9 , Anhar Ullah  1 , Hassan Mhish  10 , Abdulrahman Nouri Abdo  11 , Fawaz Almutairi  12 , Mohammed R Arafah  13 , Raed AlKutshan  14 , Mubarak Aldosari  15 , Basel Y AlSabatien  16 , Mohammad Alrazzaz  17 , Adel M Maria  18 , Aziza H Aref  19 , Muhammed M Selim  20 , Ayman M Morsy  21 , Fathi A AlTohari  22 , Ammar A Alrifai  23 , Awatif A Awaad  24 , Hassan El-Sayed  25 , Sherief Mansour  26 , Ashraf A Atwa  27 , Salah Abdelkader  28 , Naif Altamimi  29 , Elnatheer Saleh  30 , Wael Alhaidari  31 , El Husseini A ElShihawy  32 , Ali H Busaleh  33 , Mohammed Abdalmoutaleb  34 , Essam M Fawzy  35 , Zaki Mokhtar  36 , Adil M Saleh  37 , Mohammed A Ahmad  38 , Adel Almasswary  39 , Mohammed Alshehri  4 , Khalid M Abohatab  40 , Turki AlGarni  41 , Modaser Butt  42 , Ibrahim Altaj  43 , Farhan Abdullah  44 , Yahya Alhosni  45 , Hadia B Osman  46 , Najeebullah Bugti  47 , Atif A Aziz  48 , Abdulrahman Alarabi  49 , Ibrahim A AlHarbi  50
Affiliations
Multicenter Study

The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)

Khalid F Alhabib et al. PLoS One. .

Abstract

Background: Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia.

Methods: We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years.

Results: Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men.

Conclusions: There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.

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Conflict of interest statement

Astra Zeneca and Algorithm pharmaceutical companies are the commercial funders of the (STARS-1 Program). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Time-line of patients with ST-segment elevation myocardial infarction.
FMC: First medical contact; ER: emergency room; ECG: electrocardiogram; TT: thrombolytic therapy.
Fig 2
Fig 2. Medications use in the first 24 hrs of hospital admission for patients with acute myocardial infarction.
STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction.
Fig 3
Fig 3. Medications use at hospital discharge for patients with acute myocardial infarctions.
STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction.
See this image and copyright information in PMC

References

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