Saudi coronary atherothrombosis intravascular ultra sound study in patients presenting with acute coronary syndromes

Clinical Research. Presentation type: Oral Presentation. Introduction: Cardiovascular disease is the leading cause of mortality in diabetic patients. Diabetes is associated with more severe coronary stenosis. The current study is the first in Saudi Arabia that aim to establish an intravascular ultrasound (IVUS) profile of diabetic mellitus (DM) patients with acute coronary syndrome. Methodology: We retrospectively analysed 210 IVUS studies performed in 188 patients. All patients were hospitalized in King Salman Heart Center for acute coronary syndromes (ACS). The IVUS studies were carried out upon discretion of the operator to guide percutaneous interventions of borderline moderate lesions. Results: Mean age was 57.8 ± 10.1 years, 78% (n = 163) were men and 71% (n = 128) were diabetics. STEMI was the most common clinical presentation (47.8%, n = 88). As compared to non-diabetics, the intermediate lesions of DM patients had a significantly larger IVUS plaque volume (267.4  ± 173.7 mm3 versus 193.1 ± 111.1 mm3 for non DM group, p < 0.001), larger vessel volume (495.9 ± 313.6 mm3 versus 358.2 ± 181.7 mm3, p < 0.001), larger lumen volume (231.2 ± 156.2 mm3 versus 163.5 ± 87.9 mm3, p < 0.001) and longer lesions (37.37 ±  12.25 mm versus 29.93 ± 8.43 mm, p = 0.004). Positive without a significant difference. Percent plaque volume and obstruction were however not different, as well as artery remodeling index. Conclusion: Diabetic patients with ACS in Saudi Arabia have longer lesions to be treated by IVUS, but no difference in average plaque burden nor remodeling. These findings are likely to impact our understanding of the optimal percutaneous interventions for our diabetic patients

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally