Thrombolysis in Yemeni patients with acute coronary syndrome, facts and prognosis. Data from gulfrace [gulf registry of acute coronary events] - phase I

Objective: rapid coronary revascularization after ACS with ST elevation acute myocardial infarction [STEMI] is a cornerstone in management. Yemen where no primary Percutaneous Coronary Intervention available, utilizing thrombolytic therapy is the main tool for coronary reperfusion. The major objective was to highlight the magnitude of ACS among Yemeni patients, predisposing risk factors to ACS, the rate of use of thrombolytic therapy, the morbidity and mortality among those patients

Methods: gulf Race I is a prospective, multinational, multicenter survey of patients hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month

Results: 1054 Yemeni patients with ACS participated in the Gulf Race I, only 218 patients had received thrombolytic therapy out of 750 cases of STEMI or newly developed LBBB. Those 218 patients represent only 41% of all the cases [531 cases] eligible for thrombolytic therapy. The mean age 55.9 +/- 11.01 years and were mainly males. Streptokinase was commonly thrombolytic used [95.4%]. Smoking reported in 127 patient [58.3%], khat chewing in 163 patient [74.3%] while arterial hypertension in 57 cases [26.1%] and diabetes mellitus type II in 54 patients [24.8%]. The mean door to needle in those patient was 59.1 minutes. Heart failure in ACS group after thrombolytic therapy was reported in 11.5% of the patients and death in 14 patients 6.4%

Conclusions: ACS among Yemeni is one of the highest in the area, in spite of low rate of using thrombolytic therapy as a first line of revascularization in Yemen, still the time of presentation of the patient with ACS to the hospitals is late. Missing the golden hours for thrombolytic therapy in Yemeni patients with ACS is associated with high rate of morbidity and mortality. Community and physician awareness programs are needed for better management of ACS

Khat use: history and heart failure

Recent reports suggest that 20 million people worldwide are regularly using khat as a stimulant, even though the habit of chewing khat is known to cause serious health issues. Historical evidence suggests khat use has existed since the 13[th] century in Ethiopia and the southwestern Arabian regions even before the cultivation and use of coffee. In the past three decades, its availability and use spread all over the world including the United States and Europe. Most of the consumers in the Western world are immigrant groups from Eastern Africa or the Middle East. The global transport and availability of khat has been enhanced by the development of synthetic forms of its active component. The World Health Organization considers khat a drug of abuse since it causes a range of health problems. However, it remains lawful in some countries. Khat use has long been a part of Yemeni culture and is used in virtually every social occasion. The main component of khat is cathinone, which is structurally and functionally similar to amphetamine and cocaine. Several studies have demonstrated that khat chewing has unfavorable cardiovascular effects. The effect on the myocardium could be explained by its effect on the heart rate, blood pressure, its vasomotor effect on the coronary vessels, and its amphetamine-like effects. However, its direct effect on the myocardium needs further elaboration. To date, there are few articles that contribute death among khat chewers to khat-induced heart failure. Further studies are needed to address the risk factors in khat chewers that may explain khat-induced cardiotoxicity, cardiomyopathy, and heart failure

Rationale, design, methodology and hospital characteristics of the first gulf acute heart failure registry [gulf care]

There is paucity of data on heart failure [HF] in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry [Gulf CARE]. Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF [AHF]. The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States [Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain] participated in the project. The majority of hospitals were community hospitals [46%; 22/47] followed by non-University teaching [32%; 15/47 and University hospitals [17%]. Most of the hospitals had intensive or coronary care unit facilities [93%; 44/47] with 59% [28/47] having catheterization laboratory facilities. However, only 29% [14/47] had a dedicated HF clinic facility. Most patients [71%] were cared for by a cardiologist. Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region

Clinical presentation, management and outcome of acute coronary syndrome in Yemen: data from GULF RACE - 2 registry

Acute Coronary Syndrome [ACS] is increasing in Yemen in recent years and there are no data available on its short and long-term outcome. We evaluated the clinical pictures, management, in-hospital, and long-term outcomes of the ACS patients in Yemen. A 9-month prospective, multi-center study conducted in 26 hospitals from 9 governorates. The study included 30-day and 1-year mortality follow-up. One thousand seven hundred and sixty one patients with ACS were collected prospectively during the 9-month period. Patients with ST-elevation myocardial infarction [STEMI] and non-ST-elevation acute coronary syndrome [NSTEACS], including non-ST-elevation myocardial infarction and unstable angina were included. ACS patients in Yemen present at a relatively young age with high prevalence of Smoking, khat chewing and hypertension. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures were very low. In-hospital mortality was high and long-term mortality rates increased two folds compared with the in-hospital mortality.

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

Regional variability in hospital mortality in patients hospitalized with st-segment elevation myocardial infarction: findings from the gulf registry of acute coronary events

To study the short-term mortality from ST-segment elevation myocardial infarction [STEMI] in the Arabian Gulf region of the Middle East, and to examine whether these geographically and culturally related countries had similar or different outcomes. The Gulf Registry of Acute Coronary Events recruited consecutive acute coronary syndrome patients from six Middle Eastern countries over a 5-month period. Of 6,706 patients recruited, 2,626 [39%] had STEMI, and a total of 165 patients died in hospital, with a crude mortality rate of 6.3%. However, mortality rates varied geographically between 10% in Yemen, 9.6% in Oman and 3.3% in the other countries. The unadjusted odds ratio of mortality for Yemen was 3.2 [95% CI: 2.2-4.7], and 3.1 [95% CI: 1.9-4.8] for Oman, compared to other Gulf countries. Even after adjusting for age and gender, the mortality remained significantly higher, almost double, in Oman and Yemen compared to other countries. This could be understood in the light of significant differences in a number of practice pattern variables such as reperfusion therapy, timely presentation and use of evidence-based medications. We found significant variability in STEMI mortality among Gulf Arab countries and identified areas requiring further efforts to reduce excess mortality in the region

Takayasu's arteritis associated with tuberculosis in a young Yemeni woman

Takayasu's arteritis [TA] is an autoimmune disease that affects the big arteries. A possible relationship between TA and tuberculosis [TB] has been suggested. Both diseases have similar chronic inflammatory lesions and occasionally granulomas on the arterial walls. We report a case of TA associated with TB

Percutaneous transcatheter closure of patent ductus arteriosus using amplatzer duct occluder: first Yemeni experience

Results of transcatheter closure of Patent Ductus Arteriosus [PDA] using Amplatzer duct occluder are excellent and have replaced the conventional surgical closure of the PDA in the majority of the cases. To assess the immediate and short term results of Transcatheter closure of patent ductus Arteriosus < 6.5mm, using the Amplatzer Duct Occluder [ADO] for the first time in Yemen. Seventeen patients [11 females and 6 males] were diagnosed to have Patent Ductus Arteriosus between May 2003 to May 2005. They underwent an attempt of Transcatheter closure of the PDA with ADO. The median age was 5.1 years [range 7 months to 11 years], and weight ranged from 4kg to 30kg [median 5. 6 kg]. A 6F sheath was used for delivery of the ADO. The median PDA diameter at the narrowest segment was 4.1mm [range 2.5 to 6.5mm] and the mean pulmonary/systemic flow ratio [QP/QS] was 1.7:1 [range 1.2:1 to 3:1]. There was immediate and complete closure in 10/17 by angiography results. At 24 hrs, 16/17 patients had complete closure of PDAs on colour Doppler echocardiography. Ten patients out of seventeen have completed the 6 and 12 months follow-up and all had complete closure without any complications. Our initial results show that Amplatzer duct occluder is safe and effective in closing PDA in most patients with a PDA < 6.5mm in diameter