Khaled Sheeren, Ahmed Walaa Eldeen, Shalaby Ghada, Alqasimi Hadeel, Ruzaizah Rahaf Abu, Haddad Mryam, Alsabri Mroj, Almalki Seham, Kufiah Heba, Aboul Elnein Fatma, Jaha Najeeb
Banha University, Banha, Egypt.
King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia.
Egypt Heart J. 2020 May 29;72(1):31. doi: 10.1186/s43044-020-00068-y.
Acute myocardial infarction (AMI) is usually caused by rupture of an atherosclerotic plaque leading to thrombotic occlusion of a coronary artery. Cardiovascular disease has recently emerged as the leading cause of death during hajj. Our aim is to demonstrate the AMI pilgrim's related disparities and comparing them to non-pilgrim patients.
Out of 3044 of patients presented with AMI from January 2016 to August 2019, 1008 (33%) were pilgrims. They were older in age (P < 0.001) and showed significantly lower rates cardiovascular risk factors (P < 0.001 for DM, smoking, and obesity). Pilgrims were also less likely to receive thrombolytic therapy (P < 0.001), show lower rate of late AMI presentation (P < 0.001), develop more LV dysfunction post AMI (P < 0.001), and have critical CAD anatomy in their coronary angiography (P < 0.001 for MVD and = 0.02 for LM disease) compared to non-pilgrim AMI patients. Despite AMI pilgrims recorded higher rate of primary percutaneous coronary intervention (PPCI) procedures, they still showed poor hospital outcomes (P < 0.001, 0.004, < 0.001, 0.05, and 0.001, respectively for pulmonary edema, cardiogenic shock, mechanical ventilation, cardiac arrest, and in-hospital mortality, respectively). Being a pilgrim and presence of significant left ventricular systolic dysfunction, post AMI was the two independent predictors of mortality among our studied patients (P = 0.005 and 0.001, respectively).
Although AMI pilgrims had less cardiovascular risk factors and they were early revascularized, they showed higher rates of post myocardial infarction complication and poor hospital outcomes. Implementation of pre-hajj screening, awareness and education programs, and primary and secondary preventive measures should be taken in to consideration to improve AMI pilgrim's outcome.
急性心肌梗死（AMI）通常由动脉粥样硬化斑块破裂导致冠状动脉血栓闭塞引起。心血管疾病最近已成为朝觐期间的主要死因。我们的目的是展示与AMI朝圣者相关的差异，并将其与非朝圣患者进行比较。
在2016年1月至2019年8月出现AMI的3044例患者中，1008例（33%）为朝圣者。他们年龄较大（P<0.001），心血管危险因素发生率显著较低（糖尿病、吸烟和肥胖的P<0.001）。与非朝圣AMI患者相比，朝圣者接受溶栓治疗的可能性也较小（P<0.001），晚期AMI就诊率较低（P<0.001），AMI后左心室功能障碍更多（P<0.001），冠状动脉造影显示严重冠状动脉疾病解剖结构的比例更高（多支血管病变的P<0.001，左主干病变的P=0.02）。尽管AMI朝圣者的直接经皮冠状动脉介入治疗（PPCI）手术率较高，但他们的住院结局仍然较差（肺水肿、心源性休克、机械通气、心脏骤停和住院死亡率分别为P<0.001、0.004、<0.001、0.05和0.001）。作为朝圣者以及AMI后存在显著的左心室收缩功能障碍是我们研究患者中死亡率的两个独立预测因素（分别为P=0.005和0.001）。
尽管AMI朝圣者的心血管危险因素较少且早期进行了血运重建，但他们的心肌梗死后并发症发生率较高，住院结局较差。应考虑实施朝觐前筛查、提高认识和教育项目以及一级和二级预防措施，以改善AMI朝圣者的结局。
