Zubaid Mohammad, Rashed Wafa, Alsheikh-Ali Alawi A, Garadah Taysir, Alrawahi Najib, Ridha Mustafa, Akbar Mousa, Alenezi Fahad, Alhamdan Rashed, Almahmeed Wael, Ouda Hussam, Al-Mulla Arif, Baslaib Fahad, Shehab Abdulla, Alnuaimi Abdulla, Amin Haitham
Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait.
Heart Views. 2017 Apr-Jun;18(2):41-46. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_113_16.
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.
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.
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.
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.
本研究旨在描述阿拉伯海湾国家因ST段抬高型心肌梗死（STEMI）住院患者的当代管理情况及1年预后。
从海湾地区急性冠状动脉综合征（ACS）事件登记处（Gulf COAST）分析了四个海湾国家（巴林、科威特、阿曼、阿拉伯联合酋长国）29家医院收治的STEMI患者的数据。这是一项对2012年1月至2013年1月因ACS入院的连续公民进行的纵向观察性登记研究。对四个国家的患者管理情况及预后进行了分析和比较。
共有1039例STEMI患者纳入Gulf COAST登记处。平均年龄为58岁，糖尿病患病率较高（47%）。在再灌注方面，10%的患者接受了直接经皮冠状动脉介入治疗，66%接受了溶栓治疗，24%未进行再灌注。接受溶栓治疗的患者中只有三分之一的门-针时间在30分钟或更短。住院死亡率为7.4%。然而，我们注意到死亡率存在显著的地区差异（3.8%-11.9%）。在调整分析中，与科威特患者相比，阿曼患者住院死亡的可能性高出4倍。
在海湾国家，溶栓治疗是STEMI患者主要的再灌注策略。大多数患者未按照近期实践指南规定的时间接受该治疗。各国之间的预后存在显著差异。需要采取质量改进措施，以更好地遵守管理指南并缩小预后差距。
