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

Baseline characteristics, management practices, and long-term outcomes of middle eastern patients in the second gulf registry of acute coronary events [Gulf RACE-2]

Limited data are available on patients with acute coronary syndromes [ACS] and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes of in such a population. A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up. ACS patients included those with ST-elevation myocardial infarction [STEMI] and non-ST-elevation acute coronary syndrome [NSTEACS], including non-STEMI and unstable angina. The registry collected the data prospectively. Between October 2008 and June 2009, 7930 patients were enrolled. The mean age [standard deviation], 56 [17] years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes [interquartile range, 210 minutes]; 22.3% had primary percutaneous coronary intervention [PCI] and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2%, and at 1 year after hospital discharge the mortality was 9.4%; 1-year mortality was higher in STEMI [11.5%] than in NSTEACS patients [7.7%; P<.001].Compared to developed countries, ACS patients in Arabian Gulf countries present at a relatively young age and have higher rates of metabolic syndrome features. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures are low. Long-term mortality rates increased severalfold compared with in-hospital mortality

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