Smoking in Acute Myocardial Infarction Patients: Observations from a Registry Heart Hospital, Qatar.

Introduction: Studies from the US and Europe showed a decline in smoking among patients with acute myocardial infarction (AMI), but limited data are available from the Middle East. In this study, we describe the temporal trend in the prevalence, associated risk factors, and outcomes of smoking among patients with AMI in Qatar. Materials and Methods: A total of 27,648 AMI patients were analyzed from the cardiology registry at Heart Hospital, Doha, Qatar. This spans from January 1991 to May 2022. Results: Of the total, 13,562 patients (49.1%, 95% confidence interval [CI]: 48%-50%) were smokers, with a clear majority of males (98.5%). Smoking habit was found to decrease in AMI patients with increasing age (age 51-60 years, adjusted odds ratio [OR]: 0.71, 95% CI: 0.67-0.76, P = 0.001, and age ≥61 years, adjusted OR: 0.45, 95% CI: 0.42-0.48, P = 0.001, in comparison to age ≤50 years). Smoking was associated with a lower risk of inhospital mortality (adjusted OR: 0.61, 95% CI: 0.54-0.70, P = 0.001), but triglyceride, obesity, and old myocardial infarction risk factors were associated with a higher risk. A decreasing trend in current smoking habits in each quantile of the 1996-2000 year (adjusted OR: 0.82, 95% CI: 0.71-0.93, P = 0.001), 2001-2005 year (adjusted OR: 0.70, 95% CI: 0.62-0.80, P = 0.001), 2006-2010 year (adjusted OR: 0.75, 95% CI: 0.67-0.84, P = 0.001), 2011-2015 year (adjusted OR: 0.48, 95% CI: 0.42-0.54, P = 0.001), 2016-2020 year (adjusted OR: 0.48, 95% CI: 0.43-0.54, P = 0.001), and ≥2021 year (adjusted OR: 0.46, 95% CI: 0.40-0.53, P = 0.001) was observed in comparison to the quantile 1991-1995 year. Similar results were also observed in the young population (age ≤50 years) including the non-Qataris, who had 25% more smokers in comparison to Qatari nationals. Conclusion: Smoking trended down significantly; however, it remained prevalent in 50% of patients among AMI patients. Smokers were younger, with fewer traditional risk factors, and had lower inhospital mortality.

A Comparative Study of High-intensity Rosuvastatin Versus Atorvastatin Therapy Post-acute Coronary Syndrome Using Real-world Data.

A high-intensity statin is recommended for the secondary prevention of cardiovascular diseases (CVD). However, real-world evidence of the effectiveness of rosuvastatin following acute coronary syndrome (ACS) is scarce. This retrospective cohort study included patients diagnosed with ACS to compare between the 2 high-intensity statin therapies (rosuvastatin vs atorvastatin) in terms of a primary composite outcome of CVD-associated death, non-fatal ACS, and non-fatal stroke at 1 month and 12 months post discharge. The primary effectiveness outcome did not differ between the 2 groups at 1 month (1.3% vs 1%; aHR = 1.64, 95% CI 0.55-4.94, P= 0.379) and at 12 months (4.8% vs 3.5%; aHR = 1.48, 95% CI 0.82-2.67, P= 0.199). Similarly, the 2 groups had comparable safety outcomes. In conclusion, the use of high-intensity rosuvastatin compared to high-intensity atorvastatin therapy in patients with ACS had resulted in comparable cardiovascular effectiveness and safety outcomes.

Reversible hypoxic-ischemic encephalopathy post prolonged out-of-hospital cardiac arrest: A case series.

This article highlights the possibility of positive outcomes associated with prolonged CPR and anoxic brain injury contesting the idea that such patients will invariably end up in a persistent vegetative state.

Intravascular Imaging in Acute Coronary Syndrome Patients without Significant Stenosis on Coronary Angiography.

Intravascular coronary imaging has facilitated the field of interventional cardiology with multiple studies showing the superiority of intravascular image-guided percutaneous coronary interventions for the reduction of lesion revascularization rates. It also aids in understanding the mechanism of myocardial infarction with nonobstructive coronary artery disease. Despite such results, there is a slow adaptation of intravascular imaging use in the real world. We present two cases where intravascular imaging helped in the rapid understanding of the etiology of acute coronary syndrome and facilitated the management of both patients.

A Conundrum of Diagnostic Analogy Between Constrictive Pericarditis and Pericardial Tamponade.

Constrictive pericarditis and cardiac tamponade are two key pathologies of the pericardium. Both increase the intrapericardial pressure and cause adverse effects on the physiological distention and relaxation of the heart's chambers. They share multiple overlapping features and, therefore, can be very challenging to differentiate between the two with regards to clinical presentation and non-invasive imaging techniques. We present a similar case with a diagnostic challenge from the laboratory investigations and non-invasive imaging. We have discussed the pathophysiology with the common and distinguishing features of the two pathologies when there is an ambiguity.