ABSTRACT
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
ABSTRACT
Background: aim of this study was to compare the outcome of off-pump versus on-pump coronary artery bypass strategies in acute coronary syndromes setting
Methods and Results: consecutive patients for coronary artery bypass surgery [CABG] were reviewed. Cases with acute coronary syndrome [ACS] receiving emergency CABG surgery via midline sternotomy from June 2006 to September 2007 were evaluated. Altogether 27 patients were operated for ACS either off pump [OPCAB] n=16, or conventional on-pump [CPB] n-11. Seventy four grafts were performed in all with a mean of 2.74. Twenty patients between both groups had 3 or more grafts; with an aim of complete revascularization. Time from skin incision to culprit lesion revascularization was significantly reduced in OPCAB patients. OPCAB surgery led to a significant benefit in terms of less drainage loss, less transfusion requirement, less inotropic support, shorter ventilation time, and shorter intensive care unit stay
Conclusions: off-Pump strategies are associated with an improved hospital outcome for high-risk patients presenting acute coronary syndrome with or without cardiogenic shock