One year prognosis of young Middle Eastern patients undergoing percutaneous coronary interventions

Background: There is scarcity of data about the outcome in young Middle Eastern patients who undergo percutaneous coronary intervention (PCI). We sought to assess clinical and coronary angiographic features and one year outcome of young compared with older patients following PCI.Methods: Baseline clinical and coronary angiographic features and major cardiovascular events from hospital admission to one year were assessed in young patients (45 years of age).Results: Of 2426 patients; 308 (12.7%) were young. Young and older patients were predominantly males (76.3% vs. 79.8%; p=0.18) and had similar prevalence of hypertension, diabetes, dyslipidemia, and cigarette smoking. There were no differences between young and older patients in the rates of acute coronary syndrome as an indication for PCI (75.6% vs. 76.1%; p=0.90). The two groups had similar prevalence of one-vessel coronary artery disease (55.2% vs. 58.1%; p=0.37) and intervention for one vessel (74.0% vs. 72.1%; p=0.53). No significant differences were observed in the incidence of in-hospital adverse events in young compared with older patients. Incidence of adverse events in young patients at one year were not different from those in older patients, including cardiac death (3.63% vs. 2.11%), stent thrombosis (3.63% vs. 2.08%), major bleeding (1.30% vs. 1.18%), and coronary revascularization (3.65% vs. 3.24%); all p=NS.Conclusions: Among Middle Eastern patients undergoing coronary intervention; 13% were 45 years of age or younger. No favourable risk profile, coronary angiographic features or cardiovascular outcome were observed in young compared with older patients

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy

One year prognosis of young Middle Eastern patients undergoing percutaneous coronary interventions

Background: There is scarcity of data about the outcome in young Middle Eastern patients who undergo percutaneous coronary intervention (PCI). We sought to assess clinical and coronary angiographic features and one year outcome of young compared with older patients following PCI.Methods: Baseline clinical and coronary angiographic features and major cardiovascular events from hospital admission to one year were assessed in young patients (<45 years of age) compared with older patients (>45 years of age).Results: Of 2426 patients; 308 (12.7%) were young. Young and older patients were predominantly males (76.3% vs. 79.8%; p=0.18) and had similar prevalence of hypertension, diabetes, dyslipidemia, and cigarette smoking. There were no differences between young and older patients in the rates of acute coronary syndrome as an indication for PCI (75.6% vs. 76.1%; p=0.90). The two groups had similar prevalence of one-vessel coronary artery disease (55.2% vs. 58.1%; p=0.37) and intervention for one vessel (74.0% vs. 72.1%; p=0.53). No significant differences were observed in the incidence of in-hospital adverse events in young compared with older patients. Incidence of adverse events in young patients at one year were not different from those in older patients, including cardiac death (3.63% vs. 2.11%), stent thrombosis (3.63% vs. 2.08%), major bleeding (1.30% vs. 1.18%), and coronary revascularization (3.65% vs. 3.24%); all p=NS.Conclusions: Among Middle Eastern patients undergoing coronary intervention; 13% were 45 years of age or younger. No favourable risk profile, coronary angiographic features or cardiovascular outcome were observed in young compared with older patients

Statin Eligibility according to 2013 ACC/AHA and USPSTF Guidelines among Jordanian Patients with Acute Myocardial Infarction: The Impact of Gender

The objectives of this study were to evaluate statin eligibility among Middle Eastern patients admitted with acute myocardial infarction (AMI) who had no prior use of statin therapy, according to 2013 ACC/AHA and 2016 USPSTF guidelines, and to compare statin eligibility between men and women. This was a retrospective multicenter observational study of all adult patients admitted to five tertiary care centers in Jordan with a first-time AMI, no prior cardiovascular disease, and no prior statin use between April 2018 and June 2019. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was estimated based on ACC/AHA risk score. A total of 774 patients met the inclusion criteria. The mean age was 55 years (SD±11.3), 120 (15.5%) were women, and 688 (88.9%) had at least one risk factor of cardiovascular disease. Compared to men, women were more likely to be older; had a history of diabetes, hypertension, and hypercholesterolemia; and had higher body mass index, systolic blood pressure, total cholesterol, and high-density lipoproteins. Compared to women, men were more likely to have a higher 10-year ASCVD risk score (14.0% vs. 17.8%, p=0.005), and more men had a 10-year ASCVD risk score of ≥7.5% and ≥10%. The proportion of patients eligible for statin therapy was 80.2% based on the 2013 ACC/AHA guidelines and 59.5% based on the USPSTF guidelines. A higher proportion of men were eligible for statin therapy compared to women, based on both the 2013 ACC/AHA (81.4% vs. 73.5%, p=0.050) and USPSTF guidelines (62.0% vs. 45.2%, p=0.001). Among Middle Easterners, over half of patients with AMI would have been eligible for statin therapy prior to admission based on the 2013 ACC/AHA and USPSTF guidelines, with the presence of gender gap. Adopting these guidelines in clinical practice might positively impact primary cardiovascular preventive strategies in this region

Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

Background. There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines. Methods. Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline. Results. Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHA2DS2-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHA2DS2-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHA2DS2-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHA2DS2-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHA2DS2-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription. Conclusions. The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992