Determinants of in-hospital cardiac catheterization in acute coronary syndrome patients in Kuwait

Clinical trials and practice guidelines have established the efficacy of early invasive strategy for high risk acute coronary syndrome [ACS] patients. This analysis was undertaken to detect the predictors of in-hospital cardiac catheterization [prior to hospital discharge] in patients with ACS in Kuwait and to assess if this use of early catheterization was according to published guidelines. We analyzed data from a prospective registry of 2054 consecutive patients admitted to all 7 general hospitals in Kuwait with the diagnosis of ACS over a period of 6 months in 2004. Citizens were more likely to receive in-hospital catheterization than expatriates [52.1% vs 38.6%; odds ratio 1.7; 95% confidence interval [CI], 1.4 to 2.2; p<0.001]. Patients with recurrent ischemia were more likely to undergo in-hospital catheterization than patients without recurrent ischemia [55.9% vs 12.2%; odds ratio 11.2; 95% CI, 8.6 to 14.5; p<0.001]. two coronary artery disease risk factors [hyperlipidemia and positive history] were associated with high rate of in-hospital cardiac catheterization [respectively, odds ratio 1.3; 95% CI, 1.2 to 2; p<0.001 and odds ratio 1.5; 95% CI, 1.3 to 2.3; p<0.001]. Although high risk patients benefit the most from an early invasive strategy after ACS, this strategy was persrvered for those with recurrent ischemia and citizens. Other risk factors were not determinants of in-hospital cardiac catheterization. Thus, there is substantial opportunity to improve the use of this effective therapy in high risk patients

Early stroke in patients with acute myocardial infarction: incidence, risk factors and clinical outcomes

Limited data is available about stroke developing after acute myocardial infarction [AMI]. We investigated the incidence, risk factors and in-hospital outcome of stroke after AMI in clinical practice with and without use of thrombolysis. We analyzed data from a prospective registry of consecutive patients admitted to the coronary care unit [CCU] at Mubarak Al Kabeer Hospital in Kuwait. Of 2481 patients admitted with AMI between 1999 and 2003, 29 [1.2%] developed stroke during their hospital stay. Age older than 60 years [OR 5.5; 95% Cl 2.4 to 12.5; P< 0.001] and systolic blood pressure higher than 160 mmHg [OR 3.2; 95% Cl 1.lto 9.5; P< 0.04], were identified as independent predictors for stroke among patients with AMI. Patients who received thrombolytic therapy were not at an increased risk for developing stroke [OR 0.7; 95% Cl 0.2 to 2.0]. Patients developing stroke were 12 times more likely to die during hospitalization compared with patients who did not develop stroke [OR 12.6; 95% Cl 5.4 to 26.7; P< 0.001]. Stroke is an infrequent but serious complication of AMI. Older age and high systolic blood pressure at admission are independent predictors of stroke

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

Reperfusion therapy for ST-segment elevation myocardial infarction: a review of the available treatment options in Kuwait

Acute myocardial infarction is currently classified into two broad categories of ST-segment elevation [STEMI] and non-ST-segment elevation [NSTEMI] myocardial infarction, based on electrocardiographic features at the time of presentation. This classification serves as an important factor determining the type of treatment a patient receives. Reperfusion therapy is currently the standard treatment for STEMI. There are two forms of reperfusion therapy, pharmacologic and mechanical. There is strong evidence that, when carried out in a timely fashion and in appropriate circumstances, mechanical reperfusion provides lower mortality and morbidity events compared to pharmacologic reperfusion. In this article we will review the pros and cons of each of the two reperfusion therapies and comment on the treatment options available to physicians in Kuwait

Thrombolytic therapy in acute myocardial infarction: experience at a University Hospital in Kuwait

There is conclusive evidence from large clinical trials that thrombolytic therapy reduces mortality and morbidity in acute myocardial infarction [AMI]. However, only a small proportion of patients receive thrombolytic treatment. Estimates have varied from 20%-50% in North America and Europe. Data from the Arab Middle East is sparse. The purpose of our study was to determine the use of thrombolytic therapy in our hospital. We conducted a retrospective analysis of 343 patients [358 incidents of AMI], who were either discharged from or died at the coronary care unit of the Mubarak Al-Kabeer Hospital during the one-year period between June 1994 and May 1995. Our patients were relatively younger [63% were <55 years] and had a much higher prevalence [44%] of diabetes compared to European patients. We observed a high rate [62%] of thrombolysis and a lesser shortfall [8%] when compared to that reported for European patients. The main reason for withholding thrombolytic therapy was non-diagnostic electrocardiogram [ECG] on initial presentation. Women were less likely to be thrombolyzed than men [38% vs. 66%, P=0.0001]. Older patients [aged >65 years] were also less likely to be thrombolyzed than younger patients [42% vs. 66%; P=0.0006]. We conclude that the use of thrombolytic therapy in this university hospital in Kuwait is appropriate. However, as observed in other reports as well, the underutilization of thrombolytic therapy in women and the elderly needs to be addressed in future studies