Spontaneous Coronary Artery Dissection in Relation to Physical and Emotional Stress: A Retrospective Study in 4 Arab Gulf Countries.

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome and sudden cardiac death. The triggers for SCAD often do not include traditional atherosclerotic risk factors. The most commonly reported triggers are extreme physical or emotional stress. The current study compared in-hospital and follow-up events in patients with SCAD with and without reported stress. Data from 83 patients with a confirmed diagnosis of SCAD were collected retrospectively from 30 centers in 4 Arab Gulf countries (KSA, UAE, Kuwait, and Bahrain) from January 2011 to December 2017. In-hospital myocardial infarction (MI), percutaneous coronary intervention (PCI), ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, ICD placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared between those with and without reported stress. Emotional and physical stress was defined as new or unusually intense stress, within 1 week of their initial hospitalization. The median age of patients in the study was 44 (37-55) years. Foty-two (51%) were women. Stress (emotional, physical, and combined) was reported in 49 (59%) of all patients. Sixty-two percent of women with SCAD reported stress, and 51 % of men with SCAD reported stress. Men more commonly reported physical and combined stress. Women more commonly reported emotional stress (P < 0.001). The presence or absence of reported stress did not impact on overall adverse cardiovascular events (P = 0.8). In-hospital and follow-up events were comparable in patients with SCAD in the presence or absence of reported stress as a trigger.

Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry.

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P = .029).

Safety of returning patients immediately to their originating hospitals after primary percutaneous coronary intervention.

INTRODUCTION: The objective of this study was to evaluate the safety and feasibility of the immediate return of patients with ST-elevation myocardial infarction (STEMI) to their originating hospitals after primary percutaneous coronary intervention (PPCI). METHODS: This was a prospective study, conducted between January 2014 and December 2017. All patients with STEMI who were transferred for PPCI and returned back to their referring hospitals (RB group) were included and compared to the onsite STEMI population (OS group). Patient's demographics, PPCI data, bleeding and adverse cardiovascular events (ACEs) occurring during transfer, hospital stay, and at 1-month follow-up were recorded. RESULTS: A total of 156 patients in the OS group were compared against 350 patients in the RB group. We found that first medical contact to balloon time and onset of symptoms to balloon time were significantly longer in the RB group than in the OS group [110 ± 67 min vs. 46 ± 35 min (p < 0.0001) and 366 ± 300 min vs. 312 ± 120 min (p = 0.04)], respectively. There were no differences between the RB and OS groups in in-hospital ACEs: 0.3% versus 0% (p = 0.8) for death, 0.3% versus 0.6% (p = 0.79) for reinfarction, 0.6% versus 2% (p = 0.72) for bleeding, and no reported cases of repeat revascularization; and 30-day ACEs: 0.3% versus 0.6% (p = 0.82) for death, 0.3% versus 1.2% (p = 0.68) for reinfarction, 0.6% versus 2% (p = 0.74) for bleeding, and 1.1% versus 1.2% (p = 0.9) for repeat revascularization. CONCLUSION: The immediate return of patients with noncomplicated STEMI after PPCI to their referring hospitals is safe and feasible, and can be used as part of an effective reperfusion strategy.

Predictive and prognostic value of 256-slice computed tomography angiography in patients with suspected coronary artery diseases.

BACKGROUND: Coronary computed tomography angiography (CCTA) is commonly used to diagnose coronary artery diseases (CADs). We aimed to determine the utility of CCTA among patients suspected with CAD at the Prince Sultan Cardiac Center Qassim. MATERIALS AND METHODS: CCTA results of 425 cardiac patients, complaining of chest pain with suspected CAD, were used to classify coronary artery stenosis into two types: obstructive if the luminal stenosis was ≥50% or nonobstructive if it was <50%. Follow-ups were conducted through clinic or phone-based interviews to document any of the following endpoints: nonfatal myocardial infarctions (MIs) or cardiac deaths (CDs), representing the major cardiac events. All other cardiac cases, including hospitalization with unstable angina, and/or late coronary revascularization, were documented. RESULTS: Patients with a normal coronary artery were 278 (65.5%). The number of patients with nonobstructive and obstructive diseases was 85 (20%) and 62 (14.5%), respectively. After 19.6 ± 7 months of follow-up, 21 cardiac events occurred in twenty patients: five major adverse events (two CDs and three nonfatal MIs), ten hospitalizations due to unstable angina, and six late coronary revascularizations. Furthermore, the cumulative all-cardiac-event rates in patients with normal coronary arteries, nonobstructive CAD, and obstructive CAD were 3 (1%), 7 (8.2%), and 11 (17.7%), respectively. However, patients with normal CCTA had no major cardiac events during the follow-up. CONCLUSION: CCTA can provide valuable prognostic information on patients with suspected CAD. Patients are likely to have excellent intermediate outcomes if the coronary arteries are confirmed to be normal by CCTA.

Awareness of fitness to drive among cardiologists in Saudi Arabia.

OBJECTIVES: To assess the perception and awareness of cardiologists in Saudi Arabia about medical fitness to drive in different cardiovascular diseases. Methods: The study is a cross-sectional survey-based study between June 2018 and July 2018. Cardiologists were asked to complete a self-administered questionnaire inquiring about awareness of driving fitness and educating patients regarding driving risks in specific cardiovascular conditions. Results: A total of 194 cardiologists completed the study survey; there were 30.4% consultants, 59.3% specialists, and 10.3% residents. Out of 195, 72% were aware of the existence of particular international driving regulations for cardiovascular diseases, whereas 28% were not aware. Although, no Saudi guidelines assessing fitness-to-drive are available, 11% of the participants claimed awareness of such regulations. Interestingly, we found that cardiologists had never or rarely educated their patients regarding the potential risks of driving: 49% in symptomatic angina, 47% when ejection fraction is ≤35%, 39% in symptomatic valvular diseases, 26% after cardioverter defibrillators implantation, and 23% after non-elective percutaneous coronary interventions. Conclusion: There is a lack of awareness among cardiologists in Saudi Arabia about international guidelines regarding medical driving fitness. This study highlights the necessity of formulating appropriate national driving regulations for cardiovascular diseases.

Non-Gated Triple Flash Coronary Computed Tomographic Angiography in Patients with Atrial Fibrillation.

BACKGROUND: Atrial fibrillation (AF) presents a potential challenge when performing coronary computed tomography angiography (CTA). To date, there is no ideal protocol for CTA in patients with AF. We sought to design a protocol for single-heartbeat coronary CTA in patients with AF. METHODS: We enrolled 32 patients with AF and a very low probability of coronary artery disease who were referred for CTA to assess pulmonary vein anatomy for catheter ablation. A 256-slice scanner was used. Twelve patients underwent CTA using non-gated triple Flash (NGTF) consisting of three prospective electrocardiogram (ECG)-triggered helical scans with a built-in ECG simulator, while retrospectively gated helical (RGH) was used in 20 patients. Radiation dose, and a 4-point scale was used to assess coronary artery image quality between CTA scan modes. RESULTS: A total of 96 vessels were analyzed. The 4-point score showed no significant differences between the RGH and NGTF scans (2.9 ± 0.6 vs. 2.8 ± 0.8, respectively; p = 0.34). The number of coronary arteries with extensive blurring did not significantly differ between the protocols, and included four vessels (6.6%) in RGH vs. three vessels (8.3%) in NGTF (p = 0.5). Radiation exposure was significantly higher with RGH scans, with a dose-length product of 835 ± 146 mGy compared with 382 ± 35 mGy for NGTF (p < 0.0001). CONCLUSIONS: Single heartbeat NGTF CTA has comparable image quality and significantly lower radiation dose compared to RGH scans in patients with AF. Whether this protocol can be used in next-generation computed tomography scanners has yet to be determined.