Impact of diabetes on hospital adverse cardiovascular outcomes in acute coronary syndrome patients: Data from the Saudi project of acute coronary events

Diabetes mellitus [DM] is a major public health problem in Saudi Arabia. DM patients who present with acute coronary syndrome [ACS] have worse cardiovascular outcomes. We characterized clinical features and hospital outcomes of diabetic patients with ACS in Saudi Arabia. ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome [SPACE] study from December 2005 to December 2007, either with DM or newly diagnosed during hospitalization were eligible. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared with non-diabetic patients. Of the 5055 ACS patients enrolled in SPACE, 2929 [58.1%] had DM [mean age 60.2 +/- 11.5, 71.6% male, and 87.6% Saudi nationals]. Diabetic patients had higher risk-factor [e.g., hypertension, hyperlipidemia] prevalences and were more likely to present with non-ST-elevation myocardial infarction [40.2% vs. 31.4%, p < 0.001], heart failure [25.4% vs. 13.9%, p < 0.001], significant left ventricular systolic dysfunction and multi-vessel disease. Diabetic patients had higher in-hospital heart failure, cardiogenic shock, and re-infarction rates. Adjusted odds ratio for in-hospital mortality in diabetic patients was 1.83 [95% CI, 1.02-3.30, p = 0.042]. A substantial proportion of Saudi patients presenting with ACS have DM and a significantly worse prognosis. These data highlight the importance of cardiovascular preventative interventions in the general population.

Incidence of ventricular arrhythmia and associated patient outcomes in hospitalized acute coronary syndrome patients in Saudi Arabia: findings from the registry of the Saudi Project for Assessment of Acute Coronary Syndrome [SPACE]

Mortality in acute coronary syndrome [ACS] patients with ventricular arrhythmia [VA] has been shown to be higher than those without VA. However, there is a paucity of data on VA among ACS patients in the Middle Eastern countries. Prospective study of patients admitted in 17 government hospitals with ACS between December 2005 and December 2007. Patients were categorized as having VA if they experienced either ventricular fibrillation [VF] or sustained ventricular tachycardia [VT] or both. Of 5055 patients with ACS enrolled in the SPACE registry, 168 [3.3%] were diagnosed with VA and 151 [98.8%] occurred in-hospital. The vast majority [74.4%] occurred in patients with ST-segment elevation myocardial infarction. In addition, males were twice as likely to develop VA than females [OR 1.7; 95% CI 1.1- 3]. Killip class >I [OR 2.0; 95% CI 1.3-3.1]; and systolic blood pressure <90 mm Hg [OR 6.4; 95% CI 3.5-11.8] were positively associated with VA. Those admitted with hyperlipidemia [OR 0.49; 95% CI 0.3-0.7] had a lower risk of developing VA. Adverse in-hospital outcomes including re-myocardial infarction, cardiogenic shock, congestive heart failure, major bleeding, and stroke were higher for patients with VA [P?.01 for all variables] and signified a poor prognosis. The in-hospital mortality rate was significantly higher in VA patients compared with non-VA patients [27% vs 2.2%; P=.001]. In-hospital VA in Saudi patients with ACS was associated with remarkably high rates of adverse events and increased in-hospital mortality. Using a well-developed registry data with a large number of patients, our study documented for the first time the prevalence and risk factors of VA in unselected population of ACS

Baseline characteristics, management practices, and in-hospital outcomes of patients with acute coronary syndromes: Results of the Saudi project for assessment of coronary events [SPACE] registry

The Saudi Project for Assessment of Coronary Events [SPACE] registry is the first in Saudi Arabia to study the clinical features, management, and in-hospital outcomes of acute coronary syndrome [ACS] patients. We conducted a prospective registry study in 17 hospitals in Saudi Arabia between December 2005 and December 2007. ACS patients included those with ST-elevation myocardial infarction [STEMI], non-ST elevation myocardial infarction and unstable angina; both were reported collectively as NSTEACS [non-ST elevation acute coronary syndrome]. 5055 patients were enrolled with mean age +/- SD of 58 +/- 12.9 years; 77.4% men, 82.4% Saudi nationals; 41.5% had STEMI, and 5.1% arrived at the hospital by ambulance. History of diabetes mellitus was present in 58.1%, hypertension in 55.3%, hyperlipidemia in 41.1%, and 32.8% were current smokers; all these were more common in NSTEACS patients, except for smoking [all P < 0.0001]. In-hospital medications were: aspirin [97.7%], clopidogrel [83.7%], beta-blockers [81.6%], angiotensin converting enzyme inhibitors/angiotensin receptor blockers [75.1%], and statins [93.3%]. Median time from symptom onset to hospital arrival for STEMI patients was 150 min [IQR: 223], 17.5% had primary percutaneous coronary intervention [PCI], 69.1% had thrombolytic therapy, and 14.8% received it at less than 30 min of hospital arrival. In-hospital outcomes included recurrent myocardial infarction [1.5%], recurrent ischemia [12.6%], cardiogenic shock [4.3%], stroke [0.9%], major bleeding [1.3%]. In-hospital mortality was 3.0%. ACS patients in Saudi Arabia present at a younger age, have much higher prevalence of diabetes mellitus, less access to ambulance use, delayed treatment by thrombolytic therapy, and less primary PCI compared with patients in the developed countries. This is the first national ACS registry in our country and it demonstrated knowledge-care gaps that require further improvements