Khaled Sheeren, Almalki Mohammad, Shalaby Ghada, Niazi Azmat K, Ahmed Sara, Alsilami Asma, Alhazmi Mohannd, Bukhary Zeyad, Jaha Najeeb
King Abdullah Medical City, Makkah, Saudi Arabia.
Umm Al-Qura University, Mecca, Saudi Arabia.
J Saudi Heart Assoc. 2020 Aug 1;32(3):340-349. doi: 10.37616/2212-5043.1139. eCollection 2020.
Epidemiological related differences in patients presenting with ST-elevation myocardial infarction (STEMI) have not yet been fully characterized in the Middle East countries. The aim of this study was to assess gender, ethnic and racial variation in clinical profiles, presentation and treatment strategies with relation to the in-hospital outcomes.
This is a retrospective, single center study reviewing the epidemiological details of STEMI patients who were admitted to our center during the period between October 2015 and August 2019.
Out of 3079 patients presented with STEMI, 498 (16%) were women, 2170 (70%) were from Middle Eastern Countries and only 1200 (39%) were non- Arabic speakers. Women were older in age compared to men (60.04 ± 11.2 vs 55.35 ± 11.8; P < 0.001). They showed significantly higher rates of cardiovascular risk factors (P < 0.001 for diabetes mellitus (DM), hypertension (HTN) and obesity) and lower prevalence of smoking and old history of previous revascularization (P < 0.001 and 0.007, respectively). Middle Eastern Countries- STEMI patients were elderly, showed higher prevalence of DM, HTN, smoking and obesity compared to South Asian patients (p = 0.001, 0.057, <0.001, <0.001 respectively). Arabic speaking - STEMI patients showed more prevalence of DM, smoking and obesity compared to non-Arabic speaking patients (p < 0.001). Regarding STEMI localization, post myocardial infarction complications and in-hospital length of stay, there were no detected significant gender, ethnic or racial variation. Women showed higher rates of all in-hospital mortality compared to men (5% vs 3%; p = 0.027) however, no ethnic/racial mortality difference was recorded among STEMI patients. Being elderly, presence of multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF < 30%) are the three independent predictors of mortality among our patients (p = 0.013, 0.048 and <0.0001 respectively).
Our study demonstrates that there are gender, ethnic/racial-related differences in the demographics and clustered cardiovascular risk factors. However, there were no significant detected variation between both genders and different ethnic groups regarding post MI complications, management provided, and hospital outcomes except for increased the mortality rates among women. Old age, presence of multi-vessel disease and severe left ventricular systolic dysfunction have the greatest effect on in-hospital mortality among STEMI patients.
中东国家中出现ST段抬高型心肌梗死（STEMI）患者的流行病学相关差异尚未得到充分描述。本研究的目的是评估与住院结局相关的临床特征、表现和治疗策略中的性别、种族和民族差异。
这是一项回顾性单中心研究，回顾了2015年10月至2019年8月期间入住我们中心的STEMI患者的流行病学细节。
在3079例STEMI患者中，498例（16%）为女性，2170例（70%）来自中东国家，只有1200例（39%）不会说阿拉伯语。与男性相比，女性年龄更大（60.04±11.2岁对55.35±11.8岁；P<0.001）。她们显示出心血管危险因素的发生率显著更高（糖尿病（DM）、高血压（HTN）和肥胖的P<0.001），吸烟率和既往血运重建史的患病率较低（分别为P<0.001和0.007）。中东国家的STEMI患者年龄较大，与南亚患者相比，DM、HTN、吸烟和肥胖的患病率更高（分别为p = 0.001、0.057、<0.001、<0.001）。说阿拉伯语的STEMI患者与不说阿拉伯语的患者相比，DM、吸烟和肥胖的患病率更高（p<0.001）。关于STEMI的定位、心肌梗死后并发症和住院时间，未发现显著的性别、种族或民族差异。与男性相比，女性的住院总死亡率更高（5%对3%；p = 0.027），然而，STEMI患者中未记录到种族/民族死亡率差异。年龄较大、存在多支冠状动脉疾病和左心室收缩功能障碍（左心室射血分数<30%）是我们患者中死亡率的三个独立预测因素（分别为p = 0.013、0.048和<0.0001）。
我们的研究表明，在人口统计学和聚集的心血管危险因素方面存在性别、种族/民族相关差异。然而，除了女性死亡率增加外，在心肌梗死后并发症、所提供的治疗和医院结局方面，未发现两性和不同种族群体之间存在显著差异。高龄、存在多支血管疾病和严重的左心室收缩功能障碍对STEMI患者的住院死亡率影响最大。
