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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)

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
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Source of Support: None, Conflict of Interest: None


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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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