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]

Double right coronary artery presenting with acute myocardial infarction

Myocardial infarction is being found increasingly in younger individuals. We present a case of a 32-year-old male who sustained myocardial infarction and received thrombolytic therapy. Coronary angiogram showed no coronary obstruction, but an unusual coronary anomaly was diagnosed. We review the causes of myocardial infarction in young persons, and discuss whether this coronary anomaly can explain why he had myocardial infarction