Polyvascular Disease in Patients Presenting with Acute Coronary Syndrome: Its Predictors and Outcomes

We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures

16. Contrast induced nephropathy, a single Saudi tertiary center experience

Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury. Limited data exists about CIN in Saudi Arabia. We sought to explore the incidence, and characteristics of CIN victims in a Saudi tertiary care center. Methods: Patients who underwent cardiac catheterization (CC) or renal denervation between January 1st, 2012 and June 30th, 2013 were screened. CIN was defined as ⩾25% increase in Creatinine, occurring within 24–7  h after contrast exposure. Baseline characteristics, and incidence of CIN were described. Results: 437 patients were eligible for this analysis. Of those 434 underwent CC and 3 renal denervation. The mean age of the study cohort was 56.9 (±11.8). 56.6% were Saudi nationals, and 78.2% were males. Diabetes, hypertension, and pre-existing chronic kidney disease were found in 52.5%, 59.12%, and 5.35%, respectively. 73.7% were hydrated prior to the procedure, and 42.9% were hydrated following the procedure. Overall incidence of contrast-induced nephropathy was 31.3%. 56.5% developed CIN within 48 h after the index procedure; while 35.6% developed it after 96 h. All patients developing CIN recovered without dialysis. Baseline estimated GFR, and HTN were the only independent predictors for CIN. Conclusion: Our study is the first study in Saudi Arabia reporting the incidence of CIN. CIN incidence is relatively high though the overall short-term prognosis is favorable

Baseline characteristics, management practices, and long-term outcomes among patients with first presentation acute myocardial infarction in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II)

Background and objectives: Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality. Methods: We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients. Results: Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55 years vs. 53 years; p < 0.001) and had lower risk factors than patients with a history of ACS. Higher laboratory readings of cardiac markers and all aspects of mortality were significantly higher among patients with first presentation AMI. After adjustments for baseline variables, congestive heart failure [odds ratio (OR) = 1.08; 95% confidence interval (CI), 0.73–1.57], reinfarction (OR = 1.16; 95% CI, 0.58–2.30), cardiogenic shock (OR = 1.51; 95% CI, 0.74–3.08), stroke (OR = 2.30; 95% CI, 0.29–17.99), and overall mortality (OR = 1.16; 95% CI = 0.74–1.83) were independent predictive factors for first presentation AMI. Conclusions: First presentation AMI patients tend to be older and to have lower rates of risk factors. Adverse clinical outcomes such as congestive heart failure, reinfarction, cardiogenic shock, and stroke were higher among patients with first presentation AMI compared to patients with a history of ACS. Keywords: Acute coronary syndrome, Acute myocardial infarction, Middle East, Mortalit

Percutaneous coronary intervention in two patients with a solitary coronary artery from the right coronary sinus of Valsalva

Two patients with a common coronary artery arising from the right sinus of Valsalva, who underwent coronary angiography and percutaneous coronary intervention following an acute coronary syndrome, are presented. The anatomic description based on previously published classification schemes is described. The clinical implications of this rare coronary anomaly and interventional considerations are addressed

19. Disparities in health care delivery and hospital outcomes between expatriates and nationals presenting with acute coronary syndromes in Saudi Arabia

Saudi Arabia has a large expatriate population. We explored the difference and similarities between Non-Saudi patients (NS) presenting with an acute coronary syndrome and Saudi nationals (SN) with respect to therapies and clinical outcomes. Methods: ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) from 2005 to 2007 are the subjects of this analysis. 5055 patients were enrolled in SPACE. Propensity score matching and logistic regression analysis were performed to account for major imbalances in age and gender. Results: 2031 ACS patients were available for analysis. The mean age was 56.2 ± 9.8, and males formed 83.5% of the study cohort. SN were more likely to have risk factors of atherosclerosis. ST-elevation MI (STEMI) was the most common ACS presentation in NS, while Non-ST ACS was more common in SN. The median symptom to door time was significantly longer in NS patients (175 min (197) vs. 130 min (167), p = 0.027). There were no differences in pharmacological therapies between the two groups, Except that NS were more likely to receive fibrinolytic therapy. NS were less likely to undergo percutaneous coronary interventions (PCI), or primary PCI compared to Saudis (32.6% vs. 42.8%, p = 0.0001, and 7.8% vs. 22.8%, p < 0.001, respectively). Hospital mortality, cardiogenic shock, and Heart failure were significantly higher in NS compared to SN. After adjusting for baseline variables, and therapies, the odds ratio for hospital mortality, and Cardiogenic shock in NS were 2.9 (95% CI 1.5–6.2, p = 0.004), and 2.8 (1.5–4.9), p < 0.001, respectively. Conclusion: Our findings indicate disparities in hospital care between NS, and SN ACS patients. NS patients had worse hospital outcomes potentially reflecting unequal health coverage, and access to care issues

A Tailored, Bundle Care Intervention Strategy to Reduce Cardiac Mortality During the Hajj: A Population-Based, Before and After Study.

Hajj is the largest human gathering with over 2 million people. We evaluated the effect of bundle care intervention on mortality. A population-based, before and after study compared the effect of an intervention on mortality. The intervention included recruitment of cardiac team, introducing 24/7 catheterization service, cardiac coordination, standardized cardiac care pathways, and establishment of an effective transportation system. Cardiac mortality accounted for about 52% of all in-hospital deaths before intervention in 2009. This decreased significantly to 43.3%, 32.5%, and 19.7% in 2009, 2010, and 2011, respectively. In-hospital mortality of acute coronary syndromes was 4.7%, 4.6%, and 3.0%, in the years 2009, 2010, and 2011, respectively. Mortality due to other causes remained largely unaffected. There was no significant change in the national mortality due to cardiac causes over the same period provided a reassurance that the observed improvement in in-hospital acute coronary syndrome mortality was not due to overall improvement in health care. The numbers of cardiac catheterization procedures increased 3-fold and cardiac surgical procedures increased 5-fold between 2009 and 2011. In this study, we found that an evidence-based intensive bundle care intervention substantially reduced the cardiac mortality among the pilgrims assembling for Hajj in Makkah

Pulmonary hypertension in Saudi Arabia: A single center experience

Context: Several international studies have described the epidemiology of pulmonary hypertension (PH). However, information about the incidence and prevalence of PH in Saudi Arabia is unknown. Aims: To report cases of PH and compare the demographic and clinical characteristics of PH due to various causes in a Saudi population. Methods: Newly diagnosed cases of PH [defined as mean pulmonary artery pressure >25 mmHg at right heart cauterization (RHC)] were prospectively collected at a single tertiary care hospital from January 2009 and June 2012. Detailed demographic and clinical data were collected at the time of diagnosis, along with hemodynamic parameters. Results: Of the total 264 patients who underwent RHC, 112 were identified as having PH. The mean age at diagnosis was 55.8 ± 15.8 years, and there was a female preponderance of 72.3%. About 88 (78.6%) of the PH patients were native Saudis and 24 (21.4%) had other origins. Twelve PH patients (10.7%) were classified in group 1 (pulmonary arterial hypertension), 7 (6.2%) in group 2 (PH due to left heart disease), 73 (65.2%) in group 3 (PH due to lung disease), 4 (3.6%) in group 4 (chronic thromboembolic PH), and 16 (14.3%) in group 5 (PH due to multifactorial mechanisms). PH associated with diastolic dysfunction was noted in 28.6% of group 2 patients, 31.5% of group 3 patients, and 25% of group 5 patients. Conclusions: These results offer the first report of incident cases of PH across five groups in Saudi Arabia

Pulse pressure in acute heart failure: Insights from the hearts registry

Introduction: Low Pulse Pressure (PP) predicts mortality in chronic symptomatic Heart Failure (HF). Data in Acute HF (AHF) are lacking. Our aim was to examine the prognostic value of PP in AHF for short- and long-term outcomes. Methodology: Data from the Heart Function Assessment Registry Trial (HEARTS) were analyzed. AHF patients were prospectively enrolled from October 2009 to December 2010, with a mortality follow-up until January 2013. Comparisons were done according to PP median value (50 mmHg). Primary outcomes were hospital adverse events and short and long-term mortality rates. Results: 2609 patients were included. In crude comparisons, patients with low PP had higher rates of recurrence of HF (35.4% vs. 26.5%; P < 0.001), and greater risk of hospital and 30-day mortality (7.8% vs. 5.1%; P 0.006 and 9.5% vs. 6.6%; P = 0.006, respectively). There were no differences observed in long-term mortality rates. Multiple regression analyses showed no independent role for PP on all studied outcomes. However, a subgroup analysis revealed that hospital mortality was greater in HF with reduced Ejection Fraction (HFrEF). Conclusion: Low PP was not predictive of mortality in the overall AHF population. However, it still remains an important prognostic marker in the HFrEF phenotype