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Jawad A Al-Lawati,
Ibrahim Al-Zakwani,
Kadhim Sulaiman, Khalid Al-Habib,
Jassim Al Suwaidi,
Prashanth Panduranga,
Alawi A Alsheikh-Ali,
Wael Almahmeed,
Husam Al Faleh,
Shukri Al Saif,
Ahmad Hersi,
Nidal Asaad,
Ahmed Al-Motarreb,
Dimitri P Mikhailidis,
Haitham Amin
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ABSTRACT: We used prospective cohort data of patients with acute coronary syndrome (ACS) to compare their manage-ment on weekdays/mornings with weekends/nights, and the possible impact of this on 1-month and 1-year mortality. Analyses were evaluated using univariate and multivariate statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were on weekdays. There were no significant differences in 1-month (odds ratio (OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI: 0.70-1.10), respectively, between weekday and weekend admissions. Similarly, there were no significant differences in 1-month (OR, 0.92; 95% CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20), respectively, between nights and day admissions. In conclusion, apart from lower utilization of angiography (P < .001) at weekends, there were largely no significant discrepancies in the management and care of patients admitted with ACS on weekdays and during morning hours compared with patients admitted on weekends and night hours, and the overall 30-day and 1-year mortality was similar between both the cohorts.
The Open Cardiovascular Medicine Journal 09/2012;
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Jassim Al Suwaidi, Khalid Al Habib,
Nidal Asaad,
Rajvir Singh,
Ahmad Hersi,
Husam Al Falaeh,
Shukri Al Saif,
Ahmed Al-Motarreb,
Wael Almahmeed,
Kadhim Sulaiman,
Haitham Amin,
Jawad Al-Lawati,
Norah Q Al-Sagheer,
Alawi A Alsheikh-Ali,
Amar M Salam
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ABSTRACT: Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East.
For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries.
The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type -STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%).
There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
BMC Cardiovascular Disorders 08/2012; 12:64. · 1.52 Impact Factor
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Hadi A R Hadi Khafaji, Khalid Al Habib,
Nidal Asaad,
Rajvir Singh,
Ahmad Hersi,
Husam Al Falaeh,
Shukri Al Saif,
Ahmed Al-Motarreb,
Wael Almahmeed,
Kadhim Sulaiman,
Haitham Amin,
Jawad Al-Lawati,
Norah Q Al-Sagheer,
Alawi A Alsheikh-Ali,
Jassim Al Suwaidi
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ABSTRACT: BACKGROUND & HYPOTHESIS: Data on the clinical characteristics and outcome of patients presenting with acute coronary syndrome (ACS) according to their marital status is not clear. METHODS: A total of 5334 patients presenting with ACS in 65 hospitals in 6 Middle East countries in the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2) were studied according to their marital status (5024 married, 100 single, and 210 widowed patients). RESULT: When compared to married patients, widowed patients were older and more likely to be female. Widowed patients were more likely to have diabetes mellitus, hypertension, history of heart failure, and peripheral vascular disease and were less likely to be tobacco users when compared to the other groups. Widowed patients were also more likely to present with atypical symptoms and have advanced Killip class. Widowed patients were more likely to present with non-ST-elevation myocardial infarction (NSTEMI) when compared to the other 2 groups. Widowed patients were more likely to have heart failure (P = 0.001), cardiogenic shock (P = 0.001), and major bleeding (P = 0.002) when compared to the other groups. No statistically significant difference was observed in regard to duration of hospital stay, door to needle time in STEMI patients, or cardiac arrhythmias between the various groups. Widowed patients had higher in-hospital, 30-day, and 1-year mortality rates (P = 0.001). Marital status was an independent predictor for in-hospital mortality. CONCLUSION: Widowed marital status was associated with worse cardiovascular risk profile, and worse in-hospital and 1-year outcome. Future work should be focused on whether the provision of psychosocial support will result in improved outcomes among this high-risk group. Clin. Cardiol. 2011 DOI: 10.1002/clc.22034 Gulf RACE is a Gulf Heart Association (GHA) project and was financially supported by the GHA, Sanofi Aventis, and the College of Medicine Research Center at King Khalid University Hospital, King Saud University, and Riyadh, Saudi Arabia. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Clinical Cardiology 06/2012; · 2.15 Impact Factor
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Jassim Al Suwaidi, Khalid Al Habib,
Rajvir Singh,
Ahmad Hersi,
Khalid Al Nemer,
Nidal Asaad,
Shukri Al Saif,
Ahmed Al-Motarreb,
Wael Almahmeed,
Kadhim Sulaiman,
Haitham Amin,
Jawad Al-Lawati,
Nizar Al Bustani,
Norah Q Al-Sagheer,
Waleed M Ali
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ABSTRACT: The authors evaluated the prevalence and effect of the various tobacco use modalities among patients presenting with acute coronary syndrome (ACS) and compared them with non-tobacco and ex-tobacco users.
An analysis of the 2nd Gulf Registry of Acute Coronary Events conducted between October 2008 and June 2009 and which included 7930 consecutive patients hospitalised with ACS was made. Patients initially were divided into non-tobacco users, ex-tobacco users and current tobacco users. Subanalysis according to the tobacco modality used was subsequently made: cigarette, waterpipe or smokeless tobacco users.
Overall, 2834 (36%) patients were current tobacco users, 306 (3.9%) patients were waterpipe smokers and 240 patients (3%) were oral tobacco users. When compared with non-tobacco and ex-tobacco users, overall current tobacco users were younger, more likely to be male subjects and less likely to have diabetes mellitus, hypertension and dyslipidaemia. Mortality rate (p=0.001) and overall cardiovascular events (p=0.001) were lower among current tobacco users when compared with the other two groups. After adjustment for baseline variables, tobacco use was not an independent predictor of adverse events. Subset analysis demonstrates oral tobacco users and waterpipe smokers were older and more likely to be women when compared with cigarette smokers. Among the various tobacco groups, inhospital mortality rates were significantly higher among the waterpipe smokers when compared with the other two groups.
Clinical characteristics and outcomes of ACS patients depend on the tobacco modality used. Further studies are required to evaluate the impact of emerging tobacco use modalities on patients with coronary artery disease.
Postgraduate medical journal 05/2012; 88(1044):566-74. · 1.38 Impact Factor
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Kadhim Sulaiman,
Panduranga Prashanth,
Ibrahim Al-Zakwani,
Wael Al-Mahmeed,
Ahmed Al-Motarreb,
Jassim Al Suwaidi,
Haitham Amin,
Nidal Asaad,
Ahmad Hersi,
Hussam Al Faleh,
Shukri Al Saif,
Alawi A Alsheikh-Ali,
Jawad Al Lawati, Khalid Al-Habib
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ABSTRACT: The aim of this study was to evaluate the impact of admission anemia on in-hospital, one-month, and one-year mortality in patients from the Middle East with acute coronary syndrome (ACS).
Data were analyzed from 7922 consecutive patients admitted to hospitals throughout six Middle-Eastern countries with the final diagnosis of ACS, as part of Gulf RACE II (Registry of Acute Coronary Events II). Anemia at admission was defined according to the World Health Organization definition (<13 g/dL in men and <12 g/dL in women). Analyses were conducted using univariate and multivariate statistical techniques.
The median age of the cohort was 56 (48-65) years, with the majority being male (79%). Anemia at admission was present in 2241 patients (28%). Patients with anemia were more likely to have in-hospital complications including heart failure, recurrent ischemia, re-infarction, cardiogenic shock, stroke, and major bleed. Even after adjustment, anemia was still associated with mortality at in-hospital (odds ratio [OR]=1.71, 95% confidence interval [CI], 1.34-2.17; P<0.001), at one-month (OR=1.34, 95% CI, 1.06-1.71; P=0.016), and at one-year (OR=1.22, 95% CI, 1.01-1.49; P=0.049) post-admission with ACS.
Admission anemia in patients with ACS from six Middle-Eastern countries was strongly associated with mortality at in-hospital, one-month, and at one-year. Hence, admission anemia must be considered in the initial risk assessment of ACS patients along with other risk scores.
Clinical Medicine & Research 05/2012; 10(2):65-71.
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Ibrahim Al-Zakwani,
Kadhim Sulaiman,
Mohammed Al Za'abi,
Prashanth Panduranga, Khalid Al-Habib,
Nidal Asaad,
Ahmed Al Motarreb,
Ahmad Hersi,
Husam Al Faleh,
Shukri Al Saif,
Wael Almahmeed,
Haitham Amin,
Alawi Alsheikh-Ali,
Jawad Al Lawati,
Jassim Al Suwaidi
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ABSTRACT: To evaluate the impact of evidence-based cardiac medications (EBMs) on 1-month and 1-year mortality among discharged acute coronary syndrome (ACS) patients in the Middle East.
Data were analyzed from 7,567 consecutive ACS patients admitted to 66 hospitals in 6 Middle Eastern countries enrolled in the Gulf RACE II in October 2008 to June 2009. Individual EBMs or concurrent use of the EBM combination consists of an anti-platelet therapy, angiotensin-converting enzyme inhibitor (ACEI) (or angiotensin II receptor blocker (ARB)), β-blocker, and a statin at discharge, were evaluated. Analyses were performed using univariate and multivariate statistical techniques.
The mean age of the cohort was 56 +/- 12 years with 79% being males. 65% of the patients received the concurrent EBM combination at discharge. Aspirin, clopidogrel, statins, b-blockers and ACEIs/ARBs use was 96%, 71%, 95%, 82% and 81%, respectively. 70% of the patients were prescribed both aspirin and clopidogrel concurrently at discharge. Adjusting for demographic, clinical, revascularization, and country characteristics, the multivariable logistic regression models demonstrated no differences in mortality at both 1-month (3.0 vs. 3.6%; p = 0.828) and 1-year (3.5 vs. 3.5%; p = 0.976) between the concurrent EBM combination users and non-users.
The majority of the ACS patients in the Middle East were prescribed the guideline recommended EBM combination at discharge. However, potential still remains for further optimization of management. Further studies are required to examine the long term effect of concurrent use of the EBM combination on mortality in the region.
International journal of clinical pharmacology and therapeutics 04/2012; 50(6):418-25. · 1.18 Impact Factor
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Prashanth Panduranga,
Ibrahim Al-Zakwani,
Kadhim Sulaiman, Khalid Al-Habib,
Jassim Al Suwaidi,
Ahmed Al-Motarreb,
Alawi Alsheikh-Ali,
Shukri Al Saif,
Hussam Al Faleh,
Wael Almahmeed,
Nidal Asaad,
Haitham Amin,
Jawad Al-Lawati,
Ahmad Hersi
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ABSTRACT: Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in the Middle East. The objective of this study was to evaluate the clinical profile and mortality of STEMI patients who arrived in hospital within 12 hours from pain onset and received thrombolytic therapy.
This was a prospective, multinational, multi-centre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in six Middle Eastern countries during the period between October 2008 and June 2009, as part of Gulf RACE-II (Registry of Acute Coronary Events). Analyses were performed using univariate statistics.
Out of 2,465 STEMI patients, 66% (n = 1,586) were thrombolysed with namely: streptokinase (43%), reteplase (44%), tenecteplase (10%), and alteplase (3%). 22.7% received no reperfusion. Median age of the study cohort was 50 (45-59) years with majority being males (91%). The overall median symptom onset-to-presentation and door-to-needle times were 165 (95- 272) minutes and 38 (24-60) minutes, respectively. Generally, patients presenting with higher GRACE risk scores were treated with newer thrombolytic agents (reteplase and tenecteplase) (P < 0.001). The use of newer thrombolytic agents was associated with a significantly lower mortality at both 1-month (0.8% vs. 1.7% vs. 4.2%; P = 0.014) and 1-year (0% vs. 1.7% vs. 3.4%; P = 0.044) compared to streptokinase use.
Majority of STEMI patients from the Middle East were thrombolysed with streptokinase and reteplase in equal numbers. Nearly one-fifth of patients did not receive any reperfusion therapy. There was inappropriately long symptom-onset to hospital presentation as well as door-to-needle times. Use of newer thrombolytic agents in high risk patients was appropriate. Newer thrombolytic agents were associated with significantly lower mortality at 1-month and 1-year compared to the older agent, streptokinase.
Heart Views 04/2012; 13(2):35-41.
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Jassim Al Suwaidi, Khalid Al Habib,
Nidal Asaad,
Rajvir Singh,
Ahmad Hesi,
Husam Al Falah,
Sukhri Al Saif,
Ahmed Al Motarreb,
Wael Al Mahmeed,
Kadim Sulaiman,
Haithm Amin,
Jawad Al Lawati,
Norah Q Al Sagheer,
Alawi A Alsheikh Ali
Circulation 01/2012; 125. · 14.74 Impact Factor
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Waleed M. Ali,
Rajvir Singh,
Nidal Assad,
Awad Al Qahtani,
Jassim Al Suwaidi, Khalid Al Habib,
Ahmad Hersi,
Ahmed Al-Motarreb,
Hussam Al Faleh,
Shukri Al Saif,
Wael Almahmeed,
Nizar Al Bustani,
kadim Sulaiman,
Haitham Amin,
Jawad Al Lawati,
Norah Q. Al-Sagheer
Circulation 01/2012; · 14.74 Impact Factor
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Prashanth Panduranga,
Kadhim Sulaiman,
Ibrahim Al-Zakwani,
Mohammad Zubaid,
Wafa Rashed,
Wael Al-Mahmeed,
Jawad Al-Lawati,
Ahmed Al-Motarreb,
Amin Haitham,
Jassim Suwaidi, Khalid Al-Habib
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ABSTRACT: We assessed the use and determinants of cardiac catheterization during index admissions, among patients with acute coronary syndrome (ACS) in the Middle East. Data were analyzed from 8150 consecutive ACS patients enrolled prospectively. The overall rate of cardiac catheterization was 20%. Major predictors of cardiac catheterization were university hospitals, hospitals with catheterization facilities, physician type, and Gulf citizenship. High-risk patients were catheterized less compared to low-risk patients; odds ratio (OR) 0.44, 95% confidence interval (CI): 0.33-0.60, P < .001 and OR 0.68, 95% CI: 0.48-0.98, P = .037 for patients with non-ST-elevation ACS and ST-elevation myocardial infarction, respectively. The use of cardiac catheterization in patients with ACS from Middle East is low. It is related more to hospital characteristics than to baseline risks. There is a need to explore ways to increase overall rate of in-hospital cardiac catheterization in the region and direct it to patients who would benefit most.
Angiology 05/2010; 61(8):744-50. · 1.51 Impact Factor
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ABSTRACT: The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS).
COPD in patients with ACS is associated with worse outcome.
Data were derived from a prospective, multicenter, multinational study of 8167 consecutive patients hospitalized with ACS from February to June 2007 in 6 Middle Eastern countries. Data were analyzed according to the presence or absence of COPD. Demographic, management, and in-hospital outcomes were compared.
The prevalence of COPD was 5.3%. When compared with non-COPD patients, COPD patients were older and more likely to have diabetes, hypertension, and dyslipidemia. Atypical presentations were more common in COPD patients (P = 0.001). COPD patients were less likely to be treated with thrombolytic therapy (P = 0.001), beta-blockers (P = 0.001), and glycoprotein IIb/IIIa inhibitors, and more likely to receive angiotensin-converting enzyme (ACE) inhibitors. Although there was no difference in in-hospital mortality between the 2 groups, patients with COPD were more likely to have heart failure (P = 0.001). Despite the fact that COPD patients with ST-segment elevation myocardial infarction were less likely to receive thrombolytic therapy, they suffered more bleeding complications (2.8% vs 1%, P = 0.04), resulting in prolonged hospitalization. COPD was not an independent predictor of increased in-hospital mortality.
In this large cohort of patients with ACS, the prevalence of COPD was 5.3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in-hospital mortality.
Clinical Cardiology 04/2010; 33(4):228-35. · 2.15 Impact Factor
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Ayman El-Menyar,
Mohammad Zubaid,
Wael Al Mahmeed,
Kadhim Sulaiman,
Ahmed Al-Motarreb,
Haitham Amin, Khalid Al-Habib,
Rashid Alhamdan,
R Singh,
Nidal Asaad,
Jassim Al Suwaidi
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ABSTRACT: Background: Patients with acute coronary syndrome (ACS) are frequently presented with ischemic chest pain; however a considerable population had atypical presentation. We studied the clinical characteristics and outcomes of patients with atypical presentation across ACS (STEMI, NSTEMI, and unstable angina).
Methods and results: Data were collected from a prospective, multicenter, multinational study over 6 months. Patients with ACS were stratified according to the predominant symptom into; Typical (with ischemic chest pain) and Atypical (without ischemic chest pain) presentation. Patients’ characteristics and in-hospital management and outcomes were compared. We recruited 8,162 patients (76% males) presented with STEMI (39%) and NSTEACS (61%). On admission, 79% patients had typical and 21% patients had atypical presentation. Atypical group’ patients were 6 years older (55 vs 61 ys, p<.001) and had more risk factors for ACS. Age, heart rate (HR), diabetes mellitus (DM), renal failure and Killip class>1 were significant predictors of atypical presentation. This group was significantly less likely to receive evidence-based therapy and experienced significantly worse in-hospital outcomes i.e. heart failure (33.9% vs 11.6%), cardiogenic shock (9.5% vs 4.0%), hospital stay (5.5±0.05 vs 6.0 ±0.13 days, p<0.001) and higher mortality rate (overall ACS 6.9% vs 2.7%, STEMI 18.6% vs 4.5%, NSTEMI 4.2% vs 1.9% and unstable angina 2.4% vs 0.7%.p=0.00). After adjustment for confounders (age, sex, HR, DM, and SBP), atypical presentation was associated with 2-fold increase in mortality (OR 1.9, CI: 1.29 –2.75). Mortality rates were significantly higher in GRACE risk categories in patients with atypical presentation.
Conclusion: Patients with ACS who presented without typical chest pain were frequently underestimated and undertreated. Regardless of the type of ACS, atypical presentation had worse outcomes and needs more attention.
Circulation 01/2009; 120(S447). · 14.74 Impact Factor
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ABSTRACT: To identify the characteristics, treatments and hospital outcomes for patients diagnosed with acute coronary syndromes (ACS) in the Gulf area.
Prospective, multinational, multicentre, observational survey of consecutive ACS patients who were admitted to 65 hospitals during May 2006.
A total of 1484 ACS patients were recruited. The mean age was 55 years, and 76% were men. The final discharge diagnosis was ST-segment elevation myocardial infarction (STEMI) in 37%, non-ST-segment elevation myocardial infarction (NSTEMI) in 32%, left bundle branch block myocardial infarction (LBBB MI) in 2%, and unstable angina in 29%. Among patients with STEMI and LBBB MI, the reperfusion rate was 65%, with use of primary percutaneous coronary intervention in 7% and thrombolytic therapy in 93%. When thrombolytic therapy was used, the median door to needle time was 45 minutes, with 37% receiving it within 30 minutes of hospital presentation. During the first day of hospitalization, aspirin was administered to 94%, clopidogrel to 51%, and beta blockers to 65%. Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers and statins were used in 62% and 82%, respectively. Coronary angiography during hospitalization was performed in 21%. In-hospital mortality was 3%.
We were able to determine the characteristics, treatments and in-hospital outcomes of patients hospitalized with ACS in our region. There is room for improvement in using medications, reducing needle to door time and utilizing more cardiac catheterization services.
Saudi medical journal 03/2008; 29(2):251-5. · 0.52 Impact Factor
