Cholesterol embolization syndrome following thrombolytic therapy

Cholesterol embolization syndrome [CES] is a rare and serious complication of thrombolytic therapy. Awareness of this complication would lead to earlier diagnosis and better management. We report a case of a 70-year-old man who presented with acute myocardial infarction and was thrombolysed with tenecteplase. His hospital stay was complicated by acute renal failure, blue toe syndrome and livedo reticularis. Skin biopsy revealed cholesterol crystals. He eventually became dialysis dependent

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

use of evidence-based therapy in acute myocardial infarction patients admitted to hospital during the gulf registry of acute coronary events [GULF RACE]

The use of certain medications in acute myocardial infarction [AMI] is known to lower morbidity and mortality. We aimed to evaluate, through the use of performance measures, the implementation of specific guidelines-recommended pharmacotherapy in the management of AMI in patients living in the Arabian Peninsula. The Gulf Registry of Acute Coronary Events [Gulf RACE] enrolled ACS patients from 6 countries in the Arabian Peninsula. We examined the use of 7 performance measures that relate to the management of ST-segment elevation myocardial infarction [STEMI] and non-ST-segment elevation myocardial infarction [NSTEMI]. 5833 AMI patients were enrolled in Gulf RACE. In the first 24 hours of hospital arrival, 5713 [98%] patients were administered aspirin. The prescription rate at discharge was 5376 [97%] for aspirin, 4354 [78%] for beta-blockers, 5639 [84%] for statins and 3145 [57%] for clopidogrel. Left ventricular systolic function [LVSF] was evaluated in 3861 [66%] patients. Of those who had ejection fraction < 40% [921 patients], 725 [85%] received angiotensin converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB] at discharge. There was good adherence to guidelines-recommended medications in patients admitted to hospital with a diagnosis of AMI. The implementation of more performance measures need to be evaluated in order to assess the full picture of AMI management in this part of the world

Patient characteristics and practice patterns in the treatment of acute myocardial infarction in Kuwait: a pilot study

To determine the characteristics, management and outcomes of patients with acute myocardial infarction [AMI] admitted to the general hospitals and to assess the feasibility of establishing a registry for AMI in Kuwait. Subjects and We prospectively included 111 consecutive patients [94 males and 17 females, mean age 55 years] admitted to the coronary care units of the five participating hospitals during May 2000. The subjects all had a final diagnosis of AMI. A structured data collection form that included biochemical measurements was filled out for each patient. The prevalence of hypercholesterolemia, diabetes, hypertension and current smoking was 46, 45, 30 and 49%, respectively. Fifty-four of 57 patients who were eligible for thrombolytic therapy received treatment. The median time from symptom onset to thrombolytic therapy was 180 min. At discharge 93% were prescribed aspirin, 81% beta-blockers, 40% angiotensin-converting enzyme inhibitors, and 32% lipid-lowering drugs. The in-hospital mortality was 10%. Conclusions: The incidence of smoking, diabetes and hypercholesterolemia is high among our patients. Thrombolytic therapy is used regularly but insufficiently early. Based on this pilot study, it is feasible to establish an AMI registry in Kuwait