Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf Countries (Gulf COAST Registry)

Mohammad Zubaid; Wafa Rashed; Alawi A Alsheikh-Ali; Taysir Garadah; Najib Alrawahi; Mustafa Ridha; Mousa Akbar; Fahad Alenezi; Rashed Alhamdan; Wael Almahmeed; Hussam Ouda; Arif Al-Mulla; Fahad Baslaib; Abdulla Shehab; Abdulla Alnuaimi; Haitham Amin

doi:10.4103/HEARTVIEWS.HEARTVIEWS_113_16

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ORIGINAL ARTICLE

Year : 2017 | Volume : 18 | Issue : 2 | Page : 41-46

Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf Countries (Gulf COAST Registry)

Mohammad Zubaid¹, Wafa Rashed², Alawi A Alsheikh-Ali³, Taysir Garadah⁴, Najib Alrawahi⁵, Mustafa Ridha⁶, Mousa Akbar⁷, Fahad Alenezi⁸, Rashed Alhamdan⁹, Wael Almahmeed¹⁰, Hussam Ouda¹¹, Arif Al-Mulla¹², Fahad Baslaib¹³, Abdulla Shehab¹⁴, Abdulla Alnuaimi¹⁵, Haitham Amin¹⁶
¹ Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
² Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait
³ Department of Medicine, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
⁴ Department of Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain
⁵ Department of Medicine, Royal Hospital, Muscat, Oman
⁶ Department of Medicine, Al-Adan Hospital, Ministry of Health, Kuwait
⁷ Department of Medicine, Al-Sabah Hospital, Ministry of Health, Kuwait
⁸ Department of Medicine, Al-Farwaniya Hospital, Ministry of Health, Kuwait
⁹ Department of Medicine, Al-Jahra Hospital, Ministry of Health, Kuwait
¹⁰ Department of Medicine, Cleveland Clinic, Abu Dhabi, United Arab Emirates
¹¹ Department of Medicine, Tawam Hospital, Alain, United Arab Emirates
¹² Department of Medicine, Cardiac Sciences Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
¹³ Department of Medicine, Rashid Hospital, Dubai, United Arab Emirates
¹⁴ Department of Medicine, Alain Hospital, Alain, United Arab Emirates
¹⁵ Department of Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
¹⁶ Mohamed Bin Khalifa Cardiac Center, Manama, Kingdom of Bahrain

Correspondence Address:
Mohammad Zubaid
Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110
Kuwait

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_113_16

Objectives: The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods: Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013. Patient management and outcomes were analyzed and compared between the four countries. Results: A total of 1039 STEMI patients were enrolled in Gulf COAST Registry. The mean age was 58 years, and there was a high prevalence of diabetes (47%). With respect to reperfusion, 10% were reperfused with primary percutaneous coronary intervention, 66% with fibrinolytic therapy and 24% were not reperfused. Only one-third of patients who received fibrinolytic therapy had a door-to-needle time of 30 min or less. The in-hospital mortality rate was 7.4%. However, we noted a significant regional variability in mortality rate (3.8%–11.9%). In adjusted analysis, patients from Oman were 4 times more likely to die in hospital as compared to patients from Kuwait. Conclusions: In the Gulf countries, fibrinolytic therapy is the main reperfusion strategy used in STEMI patients. Most patients do not receive this therapy according to timelines outlined in recent practice guidelines. There is a significant discrepancy in outcomes between the countries. Quality improvement initiatives are needed to achieve better adherence to management guidelines and close the gap in outcomes.

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