In-hospital outcome of patients with cardiogenic shock complicating acute myocardial infarction: results from Royal hospital percutaneous coronary intervention registry, Oman

Objectives: Cardiogenic shock [CS] is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction [AMI]. The aim of this study was to determine the in-hospital mortality and clinical outcome in AMI patients presenting with CS in a tertiary hospital in Oman

Methods: This retrospective observational study included patients admitted to the cardiology department between January 2013 and December 2014. A purposive sampling technique was used, and 63 AMI patients with CS admitted to [36.5%] or transferred from a regional hospital [63.5%] were selected for the study

Results: Of 63 patients, 73% [n = 46] were Omani and 27% [n = 17] were expatriates: 79% were male and 21% were female. The mean age of patients was 60 +/- 12 years. The highest incidence of CS [30%] was observed in the 51-60 year age group. Diabetes mellitus [43%] and hypertension [40%] were the predominant risk factors. Ninety-two percent of patients had ST-elevation MI, 58.7% patients were thrombolysed, and 8% had non-ST-elevation MI. Three-quarters [75%] of CS patients had severe left ventricular systolic dysfunction [defined as ejection fraction <30%]. Coronary angiogram showed single vessel disease in 17%, double vessel disease in 40%, and triple vessel disease in 32% and left main disease in 11%. The majority of the patients [93.6%] underwent percutaneous coronary intervention [PCI], among them 23 [36.5%] underwent primary PCI. In-hospital mortality was 52.4% in this study

Conclusions: CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI

Clinical pathways for non-ST elevation acute coronary syndrome in Oman: an Oman heart association protocol for hospital quality improvement initiative

In 2012, Oman Heart Association [OHA] published its own guidelines for the management of patients with unstable angina/ non-ST-elevation myocardial infarction, the aim was not to be comprehensive but rather simplified and practical in order to reduce the gap between the long comprehensive guidelines and our actual practice. However, we still feel that the busy registrars and residents need simpler and direct clinical pathways or protocol to be used in the emergency departments, coronary care units and in the wards. Clinical pathways are now one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes in acute care