Clinical profile and mortality of ST-Segment elevation myocardial infarction patients receiving thrombolytic Therapy in the Middle East
Prashanth Panduranga1, Ibrahim Al-Zakwani2, Kadhim Sulaiman1, Khalid Al-Habib3, Jassim Al Suwaidi4, Ahmed Al-Motarreb5, Alawi Alsheikh-Ali6, Shukri Al Saif7, Hussam Al Faleh8, Wael Almahmeed6, Nidal Asaad4, Haitham Amin9, Jawad Al-Lawati10, Ahmad Hersi3
1 Department of Cardiology, Royal Hospital, Oman
2 Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University and Gulf Health Research, Oman
3 Department of Cardiology, King Khalid University Hospital, Riyadh, Saudi Arabia
4 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
5 Department of Cardiology, Faculty of Medicine, Sana's University, Sana's, Yemen
6 Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
7 Department of Cardiology, Saud AlBabtain Cardiac Centre, Dammam, United Arab Emirates
8 Department of Cardiology, Security Forces Hospital, Riyadh, Saudi Arabia
9 Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Bahrain
10 Department of Non-Communicable Diseases Surveillance and Control, Ministry of Health, Muscat, Oman
Department of Cardiology, Royal Hospital, PB 1331, Muscat-111
Source of Support: None, Conflict of Interest: None
Objective: Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in the Middle East. The objective of this study was to evaluate the clinical profile and mortality of STEMI patients who arrived in hospital within 12 hours from pain onset and received thrombolytic therapy.
Patients and Methods: This was a prospective, multinational, multi-centre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in six Middle Eastern countries during the period between October 2008 and June 2009, as part of Gulf RACE-II (Registry of Acute Coronary Events). Analyses were performed using univariate statistics.
Results: Out of 2,465 STEMI patients, 66% (n = 1,586) were thrombolysed with namely: streptokinase (43%), reteplase (44%), tenecteplase (10%), and alteplase (3%). 22.7% received no reperfusion. Median age of the study cohort was 50 (45-59) years with majority being males (91%). The overall median symptom onset-to-presentation and door-to-needle times were 165 (95- 272) minutes and 38 (24-60) minutes, respectively. Generally, patients presenting with higher GRACE risk scores were treated with newer thrombolytic agents (reteplase and tenecteplase) (P < 0.001). The use of newer thrombolytic agents was associated with a significantly lower mortality at both 1-month (0.8% vs. 1.7% vs. 4.2%; P = 0.014) and 1-year (0% vs. 1.7% vs. 3.4%; P = 0.044) compared to streptokinase use.
Conclusions: Majority of STEMI patients from the Middle East were thrombolysed with streptokinase and reteplase in equal numbers. Nearly one-fifth of patients did not receive any reperfusion therapy. There was inappropriately long symptom-onset to hospital presentation as well as door-to-needle times. Use of newer thrombolytic agents in high risk patients was appropriate. Newer thrombolytic agents were associated with significantly lower mortality at 1-month and 1-year compared to the older agent, streptokinase.