prognostic implications of timi risk scores in jordanian patients with acute coronary syndrome results from the glucometabolic abnormalities in acute coronary syndrome in Jordan [GLORY] study

Western studies have shown that TIMI [Thrombolysis In Myocardial Infarction] risk scores predict adverse events in patients with non ST-elevation acute coronary syndrome [NSTEACS] and ST-elevation myocardial infarction [STEMI]. Whether this also applies to Jordanian patients is largely unknown. We prospectively followed up 656 patients with ACS for total mortality, combined events of death, nonfatal MI or urgent coronary revascularization up to one year after admission. Of the whole group, 472 patients [72%] had NSTEACS, and 184 patients [28%] had STEMI. Among NSTEACS patients, 31.0% had a low risk score [total points 0 - 2 of 7], 43.5% had an intermediate risk score [total points 3 - 4], and 25.5% had a high risk score [total points 5 - 7]. In-hospital mortality was not different in the respective risk score groups [1.4%, 0.5%, and 3.4%, p = 0.123]. At 1 year, mortality was significantly higher in the high risk score group [12.8%] compared with the intermediate [4%] and low [1.4%] risk groups [p = 0.001]. Among STEMI patients, 58.6% had a low risk score [total points 0 - 3 of 13 - 14], 31.0% had a low intermediate risk score [total points 4 - 6], 8.0% had a high intermediate score [total points 7 - 9], and 2.4% had a high risk score [total points > 10]. In-hospital mortality rate was significantly higher in the two intermediate risk score groups [7.4%, 14.3%, respectively] and the high risk score group [50%] compared with the low risk score group [1.0%, p = 0.001]. The high risk and the two intermediate risk groups also had higher one-year mortality [75%, 28.6% and 16.7%, respectively] than the low risk group [3.9%, p = 0.001]. Similarly, composite events occurred at a significantly higher rate in patients with high risk scores than intermediate or low risk scores among NSTEACS and STEMI patients. TIMIRisk Scores and Prognosis in Jordan. Ayman J. Hammoudeh et al. In Jordanian ACS patients, high TIMI risk scores were associated with a high risk of cardiovascular events. Such patients are candidates for early aggressive therapeutic strategies

Is dyslipidemia in middle eastern patients with type 2 diabetes mellitus different from that in the West? the Jordan hyperlipidemia and related targets study [JoHARTS-3]

Prevalence of type 2 diabetes mellitus [DM] in the Middle East is rising, and dyslipidemia in diabetics contributes to the increasing incidence of cardiovascular disease in this population. Data on the prevalence of dyslipidemia in diabetics in the Middle East and whether it differs from that in the West are scarce. The Jordan Hyperlipidemia And Related Targets Study [JoHARTS] measured levels of fasting serum total cholesterol [TC], triglycerides [TG], low- and high-density lipoprotein cholesterol [LDL-C and HDL-C] in mg/dl in 5000 individuals evaluated at four tertiary-care centers and outpatient clinics. None was on lipid lowering agents at the time of enrollment. The diabetic subgroup [n=1410, 28%] was studied in JoHARTS-3 and consisted of 863 men [61%] and 547 women [39%]. Compared with nondiabetic men, those with DM had lower mean HDL-C level [38.0+10.6 vs 39.4+15.7, P=0.006] and higher mean TG level [186+78.9 vs 169+78.2, P<0.0004], but TC and LDL-C levels were similar in the two groups [208 vs 207; P=0.43, and 130 vs 132; P=0.10, respectively]. Similarly, diabetic women had lower HDL-C [43.8+14.2 vs 47.7+12.2, P<0.0001] and higher TG [189+78.8 vs 149+69.7, P<0.0001] than nondiabetic women. When diabetes coexisted with smoking, the HDL-C levels weree lower than levels among nondiabetic nonsmokers [36.9+10.1 vs 43.2+13.9, P<0.0001], and the TG levels were higher [201.5+80.9 vs 166.6+75.1, P<0.0001]. LDL-C levels <100 were found in 19% of diabetic with CAD, and levels <70 in 5% only. With each 1% increase in glycated hemoglobin [HbA1c] level; there were significant decreases in HDL-C levels [43.1 among those with Hb A1c 6-7% compared with 37.8 for Hb A1c >10%, P=.027] and significant increase in TG levels [185 to 244, P=0.02]

Resuscitation updates recent changes in adult and pediatric life support guidelines

The science of resuscitation and emergency cardiac care has recently undergone extensive evidence-based evaluations by experts from around the world to structure international guidelines that culminated in the publication of 'Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care'. These evaluations were made in an attempt to achieve an international uniformity in the training of both professionals as well as laypersons in basic and advanced life support and to create evidence- based resuscitation and emergency cardiovascular care. Herein, a succinct summary of the new or revised recommendations in these guidelines is presented focusing on the management of cardiac arrest in adults and children

survey of Jordanian physicians' management of dyslipidemia in patients with cardiovascular disease and diabetes

screening and treatment dyslipidemia are a pivotal component in managing patients with coronary artery disease. To study the attitude of jordanian physicians toward their approach in evaluating dyslipidemia, a group of physicians were asked to answer a questionnaire. of the 311 responders; 49% were residents and general practitioners, and 51% were internists or subspecialists. The participants worked either in a private clinic [27%] or in a hospital [73%]. Of the responders, only 10% would start screening adults for dyslipidemia at the age of 20 [NCEP recommendation]. Optimal cholesterol and triglyceride serum levels were considered to be <200 and <150 mg/dl respectively by 75% and 36% of the physicians. Low HDL-C was defined as any level <40 mg/dl by 48% only. Eighty percent and 72% agreed that the target LDL-C in cad and diabetic patients should be 100 mg/dl. Reduction of cardiac mortality and morbidity by lipid lowering was thought to be a correct statement by 96%.statins were thought to have rare side effects that are not of concern to the majority of the patients by 86%, while 80% noted that the most important factor that may limit prescription of statins was the high price of statins. Measuring serum lipoproteins during admission for acute coronary syndrome [ACS] was a common practice by 78% but 58% discharge >50% of their ACS patients on statins. more efforts are needed to facilitate guidelines application and integration into daily practice

Coronary ectasia in Jordanians: angiographic and clinical characteristics, 21 month prognosis, and a proposed new classification

to determine the frequency, underlying risk factors, treatment methods, complications, and prognosis of patients with pure coronary ectasia in the study group. we conducted a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Jordan University Hospital [JUH], a tertiary referral center, between the period of December 1997 and December 2000. A 21-month follow up was performed to look for primary and secondary endpoints. The primary endpoint was the major adverse cardiac event [MACE] a composite end point of unstable angina with ECG changes, myocardial infarction or cardiac death; secondary endpoints were: recurrent chest pain, need for repeat cardiac catheterization, emergency room visits for chest pain, and hospital admission for chest pain. Data were collected from catheterization films, medical records, and a telephone questionnaire results four thousand and two hundred and five coronary angiograms were performed during the period of the study. One hundred angiograms [2.4%] showed coronary ectasia of both mixed and pure types. Sixty angiograms [1.4%] showed pure ectasia with no coronary obstructive lesions. The left anterior descending artery [LAD] was the most commonly affected vessel by ectasia [93%], followed by the right coronary artery [RCA] [64%] and the circumflex artery in 57% of the patients. The primary composite endpoint [MACE] was observed in 4 patients [6.8%] including one patient [1.7%] with none ST elevation MI [NSTEMI], one [1.7%] with ST elevation inferior wall MI, one [1.7%] with unstable angina with ECG changes, and one [1.7%] death due to pulmonary edema. The secondary endpoint of recurrent chest pain was reported by 50% of the patients at the time of follow up. Twenty seven percent presented to the emergency room during this period with chest pain, and 17% required admission to the hospital due to chest pain. Repeated cardiac catheterization was needed in 5% of patients. Therefore, over a period of 21 months, patients with ectasia were at a high risk for recurrent chest pain, but have a low risk of MI and a low mortality rate a discussion of treatment modalities and a proposed new classification for ectasia are provided. coronary ectasia remains a controversial disease in its definition, etiology, and management. A prospective randomized trial is needed to find the best therapeutic approach to its management

Coronary ectasia complicated in - situ thrombosis

Coronary Ectasia [CE] is the abnormal enlargement or irregular dilatation of coronary arteries. We present a case of a 39-year-old male patient who presented with central chest pain of one-hour duration. His admission ECG showed 2 mm ST depression in I, aVL, V5, V6. Serial cardiac enzymes were normal. He was treated as a case of unstable angina with intravenous heparin. Nitrates, aspirin, and atenolol. His INR on admission was 1.3 [i.e.; subtherapeutic] Coronary angiography showed moderate ectasia in the proximal segments of left anterior descending and circumflex vessels. There was severe [almost aneurismal] ectasia of the proximal and mid segments of the right coronary artery [RCA] with a large intra-luminal filling defect suggestive of thrombus and slow- TIMI 1 grade-flow. The patient was managed with systemic intravenous thrombolysis by streptokinase [100,000 unit/ hour for 24 hours] and was continued on heparin and restarted on warfarin to keep INR between 2-3. His subsequent hospital course was uneventful. A brief discussion of ectasia and its significance and treatment is provided

Coronary steal syndrome induced by unligated LIMA branches

Coronary artery bypass graft [CABG[surgery is a standard treatment of coronary artery disease. Left internal mammary artery [LIMA] is commonly used as the arterial graft conduit to the left anterior descending artery. However, the technique of harvesting this artery requires special attention to preserve the integrity of the vessel and to ligate its branches to direct the blood to its intended direction, which is the grafted coronary artery. Failure to ligate large LIMA branches may result in coronary steal syndrome, where some of the LIMA blood will be diverted to the chest wall branches and leading to LAD hypo perfusion and subsequent myocardial ischemia. We present a case of a 43 year old male patient who presented 10 months after CABG with recurrent anginal pain with 2 mm ST depression in leads v2-v6. Serial cardiac enzymes were normal. he was treated as a case of unstable angina with intravenous heparin, nitrates, aspirin, and atenolol. Coronary angiography showed total occlusion of left anterior descending artery and severe right coronary artery [RCA] disease. The venous graft to the RCA was patent, the LIMA to LAD was patent but with 2 proximal un-ligated branches. It was decided that his symptoms recurrence is due to blood shunting through these 2 branches causing coronary steal syndrome. Coil embolization was done with immediate obliteration of blood flow in the 2 branches. He was free of pain for 7 months, and then re-admitted with unstable angina and ECG changes. Repeat coronary angiogram showed patency of both branches despite the correct positioning-albeit with some unwinding-of the coils. the patient underwent open surgical ligation of the 2 branches and remains symptom free one year after the surgery, a brief discussion and literature review is provided