Age and its relationship to acute coronary syndromes in the Saudi project for assessment of coronary events [SPACE] registry: the SPACE age study

To characterize risk profile of acute coronary syndrome [ACS] patients in different age groups and compare management provided to in-hospital outcome. Prospective multi-hospital registry. Seventeen secondary and tertiary care hospitals in Saudi Arabia. Five thousand and fifty-five patients with ACS. They were divided into four groups: /= 70 years. Main outcome measures: prevalence, utilization and mortality. Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction [STEMI] while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons [p < 0.001]. Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention

Are acute coronary syndrome patients admitted during off-duty hours treated differently? an analysis of the Saudi Project for assessment of acute coronary syndrome [space] study

It is often suggested that acute coronary syndrome [ACS] patients admitted during off-duty hours [OH] have a worse clinical outcome than those admitted during regular working hours [RH]. Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid [a period of several days marking the end of two major Islamic holidays], and national days. Of the 2825 patients qualifying for this analysis, 1016 [36%] were admitted during RH and 1809 [64%] during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction [STEMI] and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions [PCI]. The median door to balloon time was significantly longer [P<.01] in OH patients [122 min] than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients [11.1% vs 7.2%, P<.001]. STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day

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

Left lateral imaging position in routine myocardial perfusion practice

Left lateral position in myocardial perfusion imaging has been described in the literature to reduce the incidence of diaphragmatic attenuation artifact, therefore improving the specificity of the test