ABSTRACT
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.
ABSTRACT
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
ABSTRACT
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